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Catheter ablation to prevent recurrent atrial fibrillation: Anticoagulation

Author
Rod Passman, MD, MSCE
Section Editors
Bradley P Knight, MD, FACC
N A Mark Estes, III, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Ischemic stroke and systemic embolization are major causes of death and disability in patients with atrial fibrillation (AF). This topic will focus on the role of anticoagulant therapy to prevent embolization in patients scheduled to undergo catheter ablation (CA). The role of anticoagulant therapy in the broad population of patients with AF is discussed separately. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization".)

Other aspects of CA are discussed elsewhere. (See "Catheter ablation to prevent recurrent atrial fibrillation: Clinical applications" and "Maintenance of sinus rhythm in atrial fibrillation: Catheter ablation versus antiarrhythmic drug therapy" and "Overview of catheter ablation of cardiac arrhythmias" and "Patient education: Catheter ablation for the heart (The Basics)".)

OUR APPROACH TO ANTICOAGULATION

There are three periods when a decision or decisions have to be made about anticoagulation in a patient scheduled for catheter ablation (CA).

Preprocedural - We effectively anticoagulate most patients, irrespective of CHA2DS2-VASC score (table 1) or presence or absence of sinus rhythm, with either a vitamin K antagonist (VKA) or a newer oral anticoagulant (NOAC) for three weeks prior to CA. It is reasonable to not use preprocedural anticoagulation in AF patients in sinus rhythm (and who are likely to remain in sinus rhythm for three weeks prior to the procedure) with a CHA2DS2-VASC score of 0.

Periprocedural - We continue VKA in the periprocedural period. For once-a-day NOACs, we hold the dose the day before and the morning of the procedure. For twice-a-day NOACs, some of our experts hold both doses the day before the procedure while others hold only the evening dose before the procedure; no drug is given the morning of the procedure. All patients receive a continuous infusion of unfractionated heparin (UFH); the activated clotting time is maintained at greater than 300 seconds during the procedure.

          

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 21 00:00:00 GMT+00:00 2015.
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