A 60-year-old man with paroxysmal AF on anticoagulation undergoes catheter ablation (pulmonary vein isolation). Three months post-procedure, he develops recurrent AF. His CHA₂DS₂-VASc score is 3. He has no contraindication to anticoagulation. What is the recommended anticoagulation strategy after recurrence?

• A Anticoagulation can be discontinued if ablation was successful initially
• B Anticoagulation only during documented AF recurrences
• C Continue anticoagulation indefinitely regardless of AF recurrence or sinus rhythm maintenance ✓
• D Aspirin + clopidogrel as anticoagulation equivalent post-ablation

Explanation

ACC/AHA/ESC guidelines recommend that anticoagulation decisions post-AF ablation should be based on the patient's underlying stroke risk (CHA₂DS₂-VASc score) and NOT on the apparent success of the ablation procedure. Patients with CHA₂DS₂-VASc ≥2 in males or ≥3 in females should continue anticoagulation indefinitely because ablation does not reliably eliminate all paroxysmal AF, and silent (asymptomatic) recurrences still carry stroke risk. Aspirin+clopidogrel does not adequately prevent cardioembolic stroke from AF.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.