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Should We Continue Anticoagulation Indefinitely after Catheter Ablation of Atrial Fibrillation?

Author/s: 
Mark S. Link

Context
Current guidelines recommend indefinite anticoagulation after ablation of atrial fibrillation (AF) in patients with a CHA2DS2-VASc score ≥2–3, but few data support this practice. In a recent randomized trial (ALONE-AF), stopping anticoagulation 1 year after ablation did not raise stroke risk; now, another trial (OCEAN) has examined the same issue.

Researchers randomized 1300 patients with successful catheter ablation (no AF at 1 year clinically or on Holter monitoring) to receive rivaroxaban 15 mg or low-dose aspirin. Exclusion criteria included severe renal disease, hypercoagulability, and age >85. The mean CHA2DS2-VASc score was 2.2; only 10% of patients had scores ≥4.

Key Results
At 3 years, the incidence of the composite outcome (stroke, systemic embolism, or new covert stroke on MRI) did not differ significantly between treatment groups (0.8% with rivaroxaban and 1.4% with aspirin).
Major bleeding occurred slightly more often with rivaroxaban than with aspirin (1.6% and 0.6%), but this did not reach significance.

Keywords 
anticoagulants Ablation atrial fibrillation

The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis

Author/s: 
Conger, A., Burnham, T. R., Clark, T., Teramoto, M, McCormick, Z. L.

Objective. To provide an estimate of the effectiveness of basivertebral nerve (BVN) radiofrequency ablation (RFA) to
treat vertebrogenic low back pain (LBP). Design. Systematic review with single-arm meta-analysis. Population.
Persons 18 years of age with chronic LBP associated with type 1 or 2 Modic changes. Intervention. Intraosseous
BVN RFA. Comparison. Sham, placebo procedure, active standard care treatment, or none. Outcomes. The proportion
of patients treated with BVN RFA who reported 50% pain score improvement on a visual analog scale or numeric
rating scale. The main secondary outcome was 15-point improvement in Oswestry Disability Index score. Methods.
Three reviewers independently assessed articles published before December 6, 2021, in MEDLINE and Embase. The
Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to evaluate
the overall quality of evidence. Results. Of the 856 unique records screened, 12 publications met the inclusion criteria,
representing six unique study populations, with 414 participants allocated to receive BVN RFA. Single-arm metaanalysis showed a success rate of 65% (95% confidence interval [CI] 51–78%) and 64% (95% CI 43–82%) for 50%
pain relief at 6 and 12 months, respectively. Rates of 15-point Oswestry Disability Index score improvement were
75% (95% CI 63–86%) and 75% (95% CI 63–85%) at 6 and 12 months, respectively. Conclusion. According to GRADE,
there is moderate-quality evidence that BVN RFA effectively reduces pain and disability in most patients with vertebr

Keywords 
Endplate Vertebrogenic Discogenic Modic Ablation
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