For patients who have undergone ablation for atrial fibrillation with elevated bleeding risk, what is your risk/benefit approach when deciding to continue oral anticoagulation long-term?

In patients with a high bleeding risk who have undergone atrial fibrillation ablation, what approaches do you use to guide the long-term use of oral anticoagulation?

• Continue anticoagulation based on the patient's CHA2DS2-VASc score, irrespective of ablation outcomes
• Potentially discontinue anticoagulation in cases of successful ablation and lower stroke risk, with vigilant monitoring for AF recurrence
• Implement LAA occlusion during ablation for patients at significant bleeding risk, aiming to reduce the need for continued anticoagulation
• Utilize serial event monitoring or implantable loop recorders for patients off anticoagulation to catch any subclinical AF episodes
• Use wearable devices to monitor for AF in patients not on anticoagulation, to inform further treatment decisions
• Other