Feed

In recent years, catheter ablation for atrial fibrillation (AF), particularly pulmonary vein isolation, has become an increasingly used and evidence-based treatment aimed primarily at improving symptoms and quality of life. In this context, the management of oral anticoagulation (OAC) after the procedure has become a major topic of discussion within the scientific community. Current guidelines recommend continuing OAC based on the thromboembolic risk profile assessed by the CHA2DS2-VA score, regardless of the apparent success of the ablation. However, in recent years several research groups have explored the possibility of discontinuing anticoagulation after successful ablation in patients without documented arrhythmia recurrence. In particular, two recent randomized trials, ALONE-AF and OCEAN, have investigated strategies of anticoagulation discontinuation or de-escalation in the post-ablation setting, contributing to renewed debate regarding the necessity of long-term anticoagulation in selected patients. In parallel, the OPTION trial evaluated an alternative strategy based on left atrial appendage occlusion as a means to avoid long-term anticoagulant therapy. The aim of this review is to summarize and critically discuss the most recent evidence regarding antithrombotic management after AF ablation, focusing on clinical implications, methodological limitations, and potential future directions toward more individualized therapeutic strategies.