ALONE-AF Journal Club
We break down evidence-based medicine so you don't have to! This journal club will discuss the new ALONE-AF trial that is hot in the medical literature right now.
The Journal of the American Medical Association (JAMA) published the ALONE-AF study in August 2025. This post is a journal club breaking down the ALONE-AF trial and what change it may bring to our clinical practice.
Background/Overview
Title: Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation
Citation: Kim D, Shim K, Choi E, et al. Long-Term Anticoagulation Discontinuation After Catheter Ablation for Atrial Fibrillation. JAMA. Published online August 31, 2025.
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 atrial fibrillation (AF).
Background: Catheter ablation for AF has demonstrated superior efficacy over medical therapy in maintaining sinus rhythm and improving quality of life, but the effect of catheter ablation on long-term thromboembolic outcomes remains uncertain. Currently, if patients have a significant risk of thromboembolism after ablation, it is recommended to continue oral anticoagulant (AC) therapy. Cohort studies have reported a lower thromboembolic risk after discontinuation of oral AC. The ALONE-AF trial is the first prospective randomized controlled trial to assess long-term AC discontinuation after catheter ablation for AF.
Primary Efficacy Measure: First occurrence of a composite of stroke, systemic embolism, and major bleeding at 2 years.