Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation (ALONE-AF)

Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation (ALONE-AF)

JAMA
Published Online: August 31, 2025
2025;334;(14):1246-1254.
doi:10.1001/jama.2025.14679

RPAH EP Journal Club.

1. JOURNAL CLUB
Alejandro Paredes. MD, MSc, FESC.
19.09.25

3. BACKGROUND
üAF represents a major contributor to health care burden and public health
challenges.
üCatheter ablation has demonstrated superior efficacy over medical therapy in
maintaining SR and improving QoL.
üThe effect of catheter ablation on long-term thromboembolic outcomes remains
uncertain.
üBenefits and risks of prolonged oral anticoagulant therapy have yet to be
evaluated in RCT.
üIn patients who remain free of atrial arrhythmia recurrence after CA, the need for
continued anticoagulant therapy may diminish.

4. OBJECTIVE
“To evaluate whether discontinuing oral anticoagulant therapy
provides superior clinical outcomes compared with continuing
oral anticoagulant therapy in patients without documented
atrial arrhythmia recurrence after catheter ablation for AF”
ALONE-AFtrial (Anticoagulation One
year after Ablation of Atrial Fibrillation in Patients with Atrial Fibrillation)

5. METHODS
oOpen-label, multicenter, superiorityRCT.
o18 hospitalsin South Korea.
oAdultpatients(19-80 yo).
oAt least1 non-sex-relatedstrokeriskfactor.
oNo documentedrecurrenceof atrial arrhythmiaforat least1 yearaftercatheterablationforAF.
oEnrollmentand randomization: July2020, to March2023.
oPrimaryoutcome
oCompositeof stroke, systemicembolism, and majorbleeding
oSecondaryoutcomes
oStroke
oSystemicembolism
oMajorbleeding
oAdditionalsecondaryoutcomes
oTransientischemichattack
oMyocardialinfarction
oClinicallyrelevantnonmajorbleeding
oAll-cause mortality
oHospitalizationdueto anycauses

10. PRIMARY AND SECONDARY
OUTCOMES AT 2 YEARS
To prevent1 primaryoutcomeeventat 2 years, thenumberneededto treatfordiscontinuingoral
anticoagulantvs continuinganticoagulanttherapywas53 patients(95% CI, 29 to 333 patients)

12. DISCUSSION
üThe primary outcome was lower after discontinuing OAC therapy.
üThe current guideline recommendations for continuing with OAC after successful CA for AF
are not supported by RCT.
üEven among high-risk patients, discontinuing OAC was not associated with an increased risk
of stroke.
üOPTION, NOAH-AFNET 6, AVERROES
üWhen discontinuation of OAC is considered àrhythm monitoring to detect AF recurrence.

13. LIMITATIONS
üThe open-label design.
üThe overall number of events was lower than anticipated.
üA higher frequency of bleeding compared to ischemic events.
üThe study population consisted predominantly of East Asian patients and included relatively
few women.
üDirect oral anticoagulant therapy
üThe rate for major bleeding was relatively low at approximately 1.4% over 2 years.

14. CONCLUSION
üAmong patients without documented atrial arrhythmia recurrence after catheter
ablation for AF, discontinuing oral anticoagulant therapy resulted in a lower risk for the
composite outcome of stroke, systemic embolism, and major bleeding vs continuing
direct oral anticoagulant therapy.

17. JOURNAL CLUB
Alejandro Paredes. MD, MSc, FESC.
19.09.25