What question did this study set out to answer?

This analysis aimed to determine the optimal oral anticoagulant strategy after ablation in patients classified by left atrial diameter.

June 27, 2026EP EuropaceOpen Access

Left atrial size-based anticoagulation discontinuation after catheter ablation for atrial fibrillation: a post-hoc analysis of the ALONE-AF Trial

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Why the study?

Does discontinuation of oral anticoagulation reduce the composite of stroke, systemic embolism, or major bleeding in patients without recurrent atrial arrhythmia 1 year after AF ablation, regardless of left atrial diameter?

Population

840 patients with atrial fibrillation who had at least 1 non-sex-related stroke risk factor and no…

Comparison

Discontinuation of oral anticoagulant therapy vs Continuation of OAC therapy

Design

Cohort, Randomly assigned into discontinue OAC or continue OAC

Follow-up

2 years

Key result

Discontinuing oral anticoagulation 1 year post-ablation showed no significant difference in stroke, embolism, or major bleeding versus continuing therapy across left atrial diameter strata.

Authors

DKD Kim JSJ Shim ECE K Choi

Discussion

Member takes

Overview

Supports OAC discontinuation in LAD<40 mm to reduce composite events; extends RCT evidence for tailored post-ablation strategies.

Key Points

This analysis aimed to determine the optimal oral anticoagulant strategy after ablation in patients classified by left atrial diameter.
Post-hoc analysis of the ALONE-AF trial
Patients with at least one stroke risk factor were randomized to continue or discontinue anticoagulants.
Patients were stratified based on median left atrial diameter of 40 mm.
Primary outcome occurred in 1.4% of patients with LAD<40 mm and 1.1% with LAD≥40 mm (log-rank P=0.664).
In the LAD<40 mm group, 2.8% experienced the primary outcome in the continue OAC group.
In the LAD≥40 mm group, 0.6% in the discontinue OAC group experienced the primary outcome.

Structured PICO

Population

840 patients with atrial fibrillation (AF) who had at least 1 non-sex-related stroke risk factor (CHA2DS2-VASc score) and no documented recurrence of atrial arrhythmia for at least 1 year after catheter ablation, stratified by left atrial diameter (LAD) <40 mm (n=396) and ≥40 mm (n=444).

Intervention

Discontinuation of oral anticoagulant (OAC) therapy

Comparator

Continuation of OAC therapy (with direct oral anticoagulants)

Outcome

Composite of stroke, systemic embolism, or major bleeding at 2 yearscomposite

Discontinuation of oral anticoagulation 1 year after successful AF ablation appears safe and is not significantly influenced by left atrial diameter, suggesting rhythm status is more important than structural remodeling for OAC decisions.

Cite This Study

Kim et al. (2026) studied this question. Discontinuing oral anticoagulation 1 year post-ablation showed no significant difference in stroke, embolism, or major bleeding versus continuing therapy across left atrial diameter strata.

synapsesocial.com/papers/6a3f97e8125782b61d865ad5 https://doi.org/10.1093/europace/euag105.409

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June 27, 2026EP EuropaceOpen Access

Left atrial size-based anticoagulation discontinuation after catheter ablation for atrial fibrillation: a post-hoc analysis of the ALONE-AF Trial

View Full Paper

Ask AI

Bookmark

Why the study?

Population

840 patients with atrial fibrillation who had at least 1 non-sex-related stroke risk factor and no…

Comparison

Discontinuation of oral anticoagulant therapy vs Continuation of OAC therapy

Design

Cohort, Randomly assigned into discontinue OAC or continue OAC

Follow-up

2 years

Key result

Discontinuing oral anticoagulation 1 year post-ablation showed no significant difference in stroke, embolism, or major bleeding versus continuing therapy across left atrial diameter strata.

Authors

DKD Kim JSJ Shim ECE K Choi

Discussion

Member takes

Overview

Supports OAC discontinuation in LAD<40 mm to reduce composite events; extends RCT evidence for tailored post-ablation strategies.

Key Points

This analysis aimed to determine the optimal oral anticoagulant strategy after ablation in patients classified by left atrial diameter.
Post-hoc analysis of the ALONE-AF trial
Patients with at least one stroke risk factor were randomized to continue or discontinue anticoagulants.
Patients were stratified based on median left atrial diameter of 40 mm.
Primary outcome occurred in 1.4% of patients with LAD<40 mm and 1.1% with LAD≥40 mm (log-rank P=0.664).
In the LAD<40 mm group, 2.8% experienced the primary outcome in the continue OAC group.
In the LAD≥40 mm group, 0.6% in the discontinue OAC group experienced the primary outcome.

Structured PICO

Population

Intervention

Discontinuation of oral anticoagulant (OAC) therapy

Comparator

Continuation of OAC therapy (with direct oral anticoagulants)

Outcome

Composite of stroke, systemic embolism, or major bleeding at 2 yearscomposite

Cite This Study

synapsesocial.com/papers/6a3f97e8125782b61d865ad5 https://doi.org/10.1093/europace/euag105.409

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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