1. Paroxysmal / Persistent Atrial Fibrillation
-In regards to anticoagulation, his CHADS2-VASc = _____
-As per the OCEAN Trial, in patients with a CHADS2-VASc < 4 and
had no recurrence of Atrial Arrhythmia (on Holter monitoring or
ECG) - ie they remained in persistent sinus rhythm, the long
term bleeding risk of DOAC may outweigh it's potential benefit
-Thus, in patients with CHADS2-VASc < or = 3 and who have had an
AFib ablation and remain in sinus rhythm for 1 year after
ablation (ECG, Holter), it maybe reasonable to discontinue DOAC
and instead switch to ASA
-Switching to ASA is a reasonable option in this patient
population as it is equivalent to continuing low dose
Rivaroxaban in preventing strokes with lower risk of
bleeding
-The patient was explained the pros and cons as well as the
risks and benefits of the options - staying on Anticoagulation
indefinitely versus Switching from DOAC --> ASA. They
acknowledge the risks and benefit, and after carefully weighing
the options, through a Shared Decision Making model, the
decision to switch from anticoagulation to ASA was made,
balancing scientific evidence on risks and benefits with the
patient's preferences, values and goals.
-Verman, Atul et al. "Antithrombotic Therapy after Successful
Catheter Ablation for Atrial Fibrillation" NEJM 2026; 394:
323-332
PLAN:
1. Follow up in the Cardiology clinic on _____
-If no evidence of sustained tachyarrhythmias for 1 year (starting on
day of AFib ablation) as evidenced by ECG/Holter or zio patch - then
long term anticoagulation options for the patient include:
(a) Continued Anticoagulation given CHAD2-VASC = ___
(b) Switching from DOAC --> ASA per the OCEAN trial and using
the Shared Decision Making Model
-Please see above