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Anticoagulation after typical atrial flutter ablation: systematic review and meta‐analysis

2021Journal article Restricted access
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dc.contributor.authorFerreira, Afonso Nunes
dc.contributor.authorAlves, Mariana
dc.contributor.authorLima Da Silva, Gustavo
dc.contributor.authorCortez-Dias, Nuno
dc.contributor.authorDe Sousa, João
dc.contributor.authorPinto, Fausto J.
dc.contributor.authorCaldeira, Daniel
dc.date.accessioned2021-09-17T16:07:23Z
dc.date.available2021-09-17T16:07:23Z
dc.date.issued2021
dc.description© 2021Wiley Periodicals LLCpt_PT
dc.description.abstractBackground: Cavotricuspid isthmus (CTI) ablation in typical atrial flutter (AFL) restores sinus rhythm in 95% of patients, which may lead to the discontinuation of oral anticoagulation during follow-up. Therefore, we aimed to systematically review the clinical impact of oral anticoagulation in the incidence of thromboembolic events (TE) after typical AFL ablation. Methods: We searched for controlled studies evaluating the impact of anticoagulation in the incidence of TE in patients submitted to AFL ablation in MEDLINE, CENTRAL, PsycINFO database (June/2021). The primary outcome was TE events (ischemic stroke or systemic embolism). A meta-analysis was performed deriving risk ratios (RR) and 95% confidence intervals (CI). Statistical heterogeneity was measured through I2 metric. The confidence in the evidence was appraised with Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Eight observational studies with 4870 patients were included. TE events were not significantly reduced (RR 1.18, 95% CI 0.59-2.36; n = 4870; GRADE very low). A meta-regression showed that for each 10% increase in the prevalence of previous AF in the studied population, anticoagulation reduced TE risk in 32%. There were no significant differences regarding bleeding events (RR 2.16, 95% CI 0.43-10.97, I2 = 0%; GRADE low), but there was a lower all-cause mortality (RR 0.24, 95% CI 0.17-0.32, GRADE low). Conclusion: The best available evidence lacks robustness and the data did not definitely associate anticoagulation after typical AFL ablation with reduced TE.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationPacing Clin Electrophysiol. 2021 Aug 18pt_PT
dc.identifier.doi10.1111/pace.14342pt_PT
dc.identifier.eissn1540-8159
dc.identifier.issn0147-8389
dc.identifier.urihttp://hdl.handle.net/10451/49543
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherJohn Wiley & Sons, Inc.pt_PT
dc.relation.publisherversionhttps://onlinelibrary.wiley.com/journal/15408159pt_PT
dc.subjectCavotricuspid isthmus ablationpt_PT
dc.subjectOral anticoagulationpt_PT
dc.subjectThromboembolic eventspt_PT
dc.subjectTypical atrial flutterpt_PT
dc.titleAnticoagulation after typical atrial flutter ablation: systematic review and meta‐analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titlePacing and Clinical Electrophysiologypt_PT
person.familyNameNunes-Ferreira
person.familyNameAlves
person.familyNameLima da Silva
person.familyNameCortez-Dias
person.familyNamede Sousa
person.familyNamePinto
person.familyNameCaldeira
person.givenNameAfonso
person.givenNameMariana
person.givenNameGustavo
person.givenNameNuno
person.givenNameJoão
person.givenNameFausto J.
person.givenNameDaniel
person.identifier1153684
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person.identifier.orcid0000-0002-2836-9497
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person.identifier.orcid0000-0002-8034-4529
person.identifier.orcid0000-0002-2520-5673
person.identifier.ridO-3034-2016
person.identifier.ridG-9363-2015
person.identifier.scopus-author-id56591535500
person.identifier.scopus-author-id7102740158
person.identifier.scopus-author-id36623384200
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
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