When Does High Risk for Stroke Become Low Risk After Atrial Fibrillation Ablation?

The standard treatment for patients with a CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score of 2 or more and documented atrial fibrillation (AF) is to maintain chronic oral anticoagulation (OAC) therapy. Because of the concern about high rates of recurrence after AF ablation, the published guidelines from 2012 recommended continuing OAC therapy in patients with a high CHA₂DS₂-VASc score after ablation.¹ During follow-up, our patients without recurrence of AF frequently introduce a common refrain: “My AF is gone—why am I still on OAC? You don’t start OAC in patients with risk factors but no AF, do you?”