Discontinuing Anticoagulant Therapy After Catheter Ablation for AF Is Safe if Atrial Arrhythmia Does Not Recur After 1 Year

Is it safe to discontinue oral anticoagulant therapy after 1 year in adults without recurrence of atrial arrhythmia following catheter ablation for atrial fibrillation (AF)?

The study found that discontinuing oral anticoagulant therapy in adults at intermediate or high risk of thromboembolism (CHA₂DS₂-VASc [congestive heart failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, sex (female)] score of 1 to 3) without recurrent atrial arrhythmia 1 year after catheter ablation for AF results in a lower risk of stroke, systemic embolism, and major bleeding compared with continuing anticoagulant therapy. (Level of Evidence = 1b)

The risk of long-term thromboembolic outcomes following catheter ablation for AF remains uncertain. The investigators identified 840 adults aged 19 to 90 years who were previously treated for AF with catheter ablation. Eligibility criteria included only patients at intermediate or high risk of thromboembolism (defined as a CHA₂DS₂-VASc score of 1 or more for men or 2 or more for women) and without any recurrence of atrial arrhythmia for at least 1 year after ablation. Study patients randomly received assignment to continue or discontinue oral anticoagulant therapy. Individuals who were masked to treatment group assignment assessed outcomes. Complete follow-up occurred for 88.7% of participants at 2 years.

Using intention-to-treat and per-protocol analyses, the primary outcome of a composite of stroke, systemic embolism, and major bleeding occurred significantly less often in the discontinue group vs the continue group (0.3% vs 2.2%; number needed to treat for discontinuing vs continuing anticoagulation = 53; 95% CI, 29–333). In addition, ischemic stroke and major bleeding individually both occurred less in the discontinue group, but this difference was statistically significant only for major bleeding. [corrected]

Study design: Randomized controlled trial (single-blinded)

Funding source: Government, foundation, and industry

Allocation: Concealed

Setting: Outpatient (any)

Reference: Kim D, Shim J, Choi EK, et al.; ALONE-AF Investigators. Long-term anticoagulation discontinuation after catheter ablation for atrial fibrillation: the ALONE-AF randomized clinical trial. JAMA. 2025;334(14):1246-1254.