Ali Bozorgi: Our Meta-Analysis on Oral Anticoagulation After AF Ablation Featured in EP Europace
Ali Bozorgi, Dean of Tehran Heart center EP ward, Cardiac Electrophysiologist, Director of EP Fellowship program at Tehran University of Medical Sciences, Tehran Heart Center, Cardiologist at Tehran University of Medical Sciences, shared a post on LinkedIn:
“Delighted to share that an independent editorial has been published in EP Europace (ESC Journals) discussing our recent meta-analysis on oral anticoagulation after atrial fibrillation ablation.
The editorial, authored by Prof. Giuseppe Boriani, Dr. Gianluca Botto, and Dr. Davide Antonio Mei from the University of Modena and Reggio Emilia, offers a thoughtful synthesis of our findings alongside the two recent randomized trials in this space, ALONE-AF and OCEAN.
Key takeaways from the editorial:
- Our meta-analysis of 31 studies and over 50,000 patients showed that in patients with CHA₂DS₂-VASc score of at least 2, continuation of OAC after successful AF ablation was associated with approximately 50% reduction in stroke and TIA risk (with no between-study heterogeneity).
- The editorial highlights that both ALONE-AF and OCEAN enrolled predominantly low-risk populations, with only about one-third of participants having CHA₂DS₂-VASc score of at least 3, leaving them underpowered to detect meaningful differences in stroke outcomes.
- ALONE-AF recorded only 9 primary outcome events over 2 years; OCEAN was terminated early for futility and used a reduced-dose rivaroxaban regimen.
- Bottom line from the editorial: ‘A successful AF ablation modifies rhythm; it does not necessarily eliminate risk.’ In patients with CHA₂DS₂-VA score of at least 2, oral anticoagulation should remain a cornerstone of long-term management, regardless of apparent procedural success, in line with the 2024 ESC Guidelines.
Grateful to see our work contributing to this important clinical conversation, and thankful to the editorialists for their rigorous and balanced appraisal.
Special thanks once again to Dr. Ehsan Amini-Salehi for his dedication throughout, and to my co-authors including Prof. Arash Arya.
Title 1: Clinical outcomes of continuing vs. discontinuing oral anticoagulation after atrial fibrillation ablation: an updated systematic review and meta-analysis of observational studies and randomized controlled trials
Authors: Sandeep Samethadka Nayak, Ehsan Amini-Salehi, Negin Letafatkar, Arash Arya, Shahriar Ghodous, Maryam Jafari, Amir Nasrollahizadeh, Anoop Gurram, Javad Nadali, Seyedeh Mohadese, Mosavi Mirkalaie, Anya Patel, Payam Kabiri, Darshan Madhav Sonde, Bita Amirian, Ali Bozorgi
Read the Full Article on EP Europace
Title 2: Risks of discontinuation of anticoagulation after atrial fibrillation ablation in high-risk patients
Authors: Giuseppe Boriani, Gianluca Botto, Davide Antonio Mei
Read the Full Article on EP Europace
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