Meta-analysis Of Both Safety And Feasibility Of Withdrawing Oral Anticoagulants After 3 Months Of Successful Radiofrequency Catheter Ablation In Patients With Atrial Fibrillation

Background:Atrial fibrillation(AF)is the most common cardiac arrhythmia in clinical.The morbidity of AF increases with age.The main hazard of AF is complication with thromboembolism(TE)such as stroke and systemic embolism ect.The goal of treatment in AF is mainly to prevent TE.Radiofrequency catheter ablation(RFCA)is a method for the conversion of AF to normal sinus rhythm.The effect of RFCA is superior to cardioversion or conversion with antiarrhythmic drugs(AAD).But the anticoagulation therapy for AF after RFCA is the main challenge for us.Objectives:To evaluate both safety and feasibility of withdrawing oral anticoagulants(OACs)after 3 months of successful radiofrequency catheter ablation of AF.Methods:A systematic searched of Pub Med,Ovid and Cochrane Library for clinical trials which evaluate the differences of TE and hemorrhage between patients without and with OACs after 3 months of successful RFCA.The relevant references were manually retrieved.The eligible studies were selected and then extracted relevant information,according to pre-set inclusion criteria for meta-analysis.The data was combined with fixed effect model.The morbidity of complication was expressed as relative risk(RR)and 95% confidence interval(CI).Chi-square test was performed for heterogeneity and quantified by I2.Subgroup analysis and sensitivity analysis were also performed.Results:There were 7 literatures met a criterion were analyzed.A total of 9078 patients involved were divided into two groups:treatment group included 6066 patients without OAC and control group included 3012 patients with OAC after 3 months of successful RFCA.Meta analysis showed there were no significant differences between two groups in TE(RR 0.76,95%CI,0.47-1.21,P=0.24),and mild heterogeneity in result(P=0.16,I2=37%).After categoried by follow-up time,we founded that treatment group has less risk of TE than control group in patients with <3 years follow-up(RR0.12,95%CI,0.03-0.58,P=0.008).There were no significant differences between two groups in ≥3 years follow-up(RR0.94,95 %CI,0.56-1.58,P=0.82).The same results could be founded in the age of <60 years old(RR0.50,95 % CI,0.27-0.94,P=0.03)and≥60 years old(RR1.25,95 %CI,0.60-2.61,P=0.55).There were no statistically significant differences in heterogeneity between two subgroups.The risk of hemorrhage of treatment group was significantly less than control group(RR 0.05,95%CI,0.02-0.13,P<0.00001).By compared the TE with hemorrhage in different CHADS2 score of two groups we can found,there were no significant differences between two groups in TE both in CHADS2< 2 and ≥2(RR 0.79,95 % CI,0.29-2.15,P=0.65;RR 0.82,95 %CI,0.33-2.04,P=0.66),while the risk of hemorrhage of treatment group was less than control group(RR0.06,95 % CI,0.01-0.26,P=0.0001;RR 0.09,95 %CI,0.02-0.46,P=0.004).Conclusions:The withdraw of oral anticoagulants after 3 months of successful radiofrequency catheter ablation for patients with AF is safe and feasible.