The optimal duration of oral anticoagulation (OAC) after apparently successful catheter ablation for atrial fibrillation (AF) remains controversial. Although ablation can substantially reduce AF recurrence, uncertainty persists regarding whether stroke risk decreases sufficiently to allow safe discontinuation of anticoagulation therapy.

In a study published in the European Heart Journal Open, investigators conducted a systematic review and meta-analysis of randomized controlled trials evaluating continuation versus discontinuation of OAC after successful AF ablation. MEDLINE, Embase, and Scopus were searched through November 2025. 

Findings

• The analysis included 2,324 patients from three randomized controlled trials who remained arrhythmia-free for at least six months following AF ablation.
• Discontinuation of OAC did not increase stroke risk compared with continued anticoagulation (0.69% vs 0.86%; risk difference 0.24%; 95% CI −0.67% to 1.15%; p=0.61).
• No systemic embolic events were reported in either treatment group during follow-up.
• Annualized stroke incidence remained low and was similar between groups (incidence rate ratio 1.32; 95% CI 0.32–5.41; p=0.70).
• Continuation of OAC was associated with a significantly higher risk of major bleeding compared with discontinuation (0.90% vs 0.34%; risk difference 0.91%; 95% CI 0.17–1.65%; p=0.02).

Investigators concluded that among carefully selected patients who remain free of AF recurrence after catheter ablation, discontinuation of anticoagulation did not appear to increase thromboembolic risk while significantly reducing major bleeding events.