STUDY EVALUATES STOPPING ANTICOAGULATION IN ATRIAL FIBRILLATION TREATED WITH CATHETER ABLATION
Patients were randomized to stopping or continuing a direct-acting oral anticoagulant
Straight Healthcare
September 2025
September 2025
Catheter ablation has become a common treatment for atrial fibrillation (AF), and many patients undergo the procedure in hopes of stopping anticoagulation. Catheter ablation success, defined as no atrial arrhythmias, depends on the type of AF and the length of follow-up. One-year success rates for paroxysmal AF are 70% to 85%, while persistent AF has a success rate of 50% to 70%. Over longer follow-up periods, success rates decline. Since catheter ablation is not 100% curative, and AF can come and go without symptoms, stopping anticoagulation after the procedure may increase stroke risk. Conversely, continuing anticoagulation increases bleeding risk. To examine the issue, researchers performed the ALONE-AF trial, where 840 patients (median CHA2DS2-VASc score of 2) with AF who had undergone catheter ablation and had no documented AF recurrence for at least one year were randomized to continuing anticoagulation (with apixaban or rivaroxaban) or stopping it. No atrial arrhythmia recurrence was documented with ECGs and at least two sessions of 24- to 72-hour Holter monitoring, with at least one performed within two months of enrollment. After two years, the primary outcome, a composite of stroke, systemic embolism, and major bleeding, was observed in 0.3% of the discontinue group and 2.2% of the continue group (P=0.02). Stroke was seen in 0.3% and 1.4%, respectively, and major bleeding in 0% and 1.4% (P=0.03).
Prior to this study, providers had limited data on the risks and benefits of stopping anticoagulation after ablation. The criteria used in the study for documenting no AF recurrence (at least two sessions of 24- to 72-hour Holter monitoring without atrial arrhythmia) serve as a starting point for selecting patients for anticoagulant discontinuation. Most patients in the study had paroxysmal AF (68%), which is more responsive to ablation. Although the study did not find differences in outcomes for patients with persistent AF, this subgroup was underrepresented.
Prior to this study, providers had limited data on the risks and benefits of stopping anticoagulation after ablation. The criteria used in the study for documenting no AF recurrence (at least two sessions of 24- to 72-hour Holter monitoring without atrial arrhythmia) serve as a starting point for selecting patients for anticoagulant discontinuation. Most patients in the study had paroxysmal AF (68%), which is more responsive to ablation. Although the study did not find differences in outcomes for patients with persistent AF, this subgroup was underrepresented.
