New AFib Studies Reshape Treatment Strategies

Four major studies presented at AHA 2025 are reshaping strategies for managing atrial fibrillation (AFib) in complex clinical scenarios. OCEAN addresses weather ongoing anticoagulation is necessary after triumphant catheter ablation, offering fresh insights into stroke prevention and bleeding risk. ADAPT AF-DES and OPTIMA-AF explore optimal antithrombotic approaches after PCI, while CLOSURE-AF evaluates left atrial appendage closure (LAAC) vs. medical therapy in high-risk patients.

In OCEAN, together published in NEJM, rivaroxaban didn’t result in a significantly lower incidence of stroke, systemic embolism or new covert embolic stroke compared with aspirin among patients at high risk for stroke who had undergone a catheter ablation for atrial AFib at least one year prior.

Researchers randomized 1,284 patients to either aspirin (70-120 mg daily) or rivaroxaban (15 mg daily) with an average follow-up period of three years. The primary outcome was a composite of stroke, systemic embolism, or new covert embolic stroke.

Overall results showed a primary-outcome event occurred in five patients assigned to rivaroxaban compared with nine patients in the aspirin group. Researchers noted that new cerebral infarcts measuring less than 15 mm occurred in 3.9% of patients receiving rivaroxaban (n=22/568) and 4.4% receiving aspirin (n=26/590). However, fatal or major bleeding (the composite primary safety outcome) was higher in the rivaroxaban group compared with the aspirin group at 3 years (1.6% vs. 0.6%).

“In essence, catheter ablation for AFib reduced the recurrence of AFib and can also reduce the risk of stroke associated with this common heart rhythm condition,” said Atul Verma, MD, FACC, in presenting the findings. “With the notably increased bleeding risk associated with rivaroxaban, we concluded that the anticoagulant didn’t offer any advantages in comparison to aspirin for reducing what we found to be a low stroke risk in these individuals.”