Abstract 9757: Real World Experience With Anticoagulation in Atrial Fibrillation Patients After Pulmonary Vein Isolation: Associations With Cha 2 Ds 2 -vasc Score, Sex and Maintenance of Sinus Rhythm

Abstract

Background: Guidelines recommend using the CHA 2 DS 2 -VASc score to determine anticoagulation decisions in atrial fibrillation (AF) patients, including those who undergo pulmonary vein isolation (PVI), however this may not consistently occur in the real-world setting because of other clinical factors. We sought to evaluate the anticoagulation prescription patterns in AF patients 1 year PVI at our institution. Methods: Consecutive AF patients undergoing PVI in our prospective registry during 2014-2018 who were alive at 1-year post-PVI were studied. Anticoagulation prescription rates at this time-point were adjudicated, and correlated to CHA 2 DS 2 -VASc score, sex and maintenance of normal sinus rhythm (NSR) at 1 year. Results: Amongst 4596 patients undergoing PVI, mean age was 64.1±10.0 years, 3308 (71.2%) were male, and based on CHA 2 DS 2 -VASc Score anticoagulation was not indicated, can be considered and indicated in 872 (19.0%), 1183 (25.7%) and 2541 (55.3%) patients respectively. At 1-year after PVI, 3504 (76.2%) patients were on anticoagulation, and 792 (17.2%) had recurrence of AF. Anticoagulation rates by sex, CHA 2 DS 2 -VASc Score category and NSR at 1-year after PVI are illustrated in the Figure. Anticoagulation was continued in over half of AF patients without classic CHA 2 DS 2 -VASc indication particularly in those with AF recurrence and women, while they were mildly under-prescribed in those with indication, especially for those without AF recurrence and men. Conclusion: In a large real world cohort of patients post PVI, anticoagulation is prescribed independent of CHA 2 DS 2 -VASc score, and is affected by both sex and NSR status. Factors determining continuous anticoagulation after successful PVI may include parameters not covered in the CHA 2 DS 2 -VASc score such as return of atrial mechanical function on echocardiography, valve disease or extra-cardiac pathologies.