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Periprocedural Anticoagulation Management for Atrial Fibrillation Ablation: Current Knowledge and Future Directions

  • Arrhythmia (GA Upadhyay, Section Editor)
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Abstract

Catheter ablation (CA) for atrial fibrillation (AF) is an established first-line approach to the management of drug-refractory AF. Although, advancements in procedural techniques and technology have improved the efficacy and safety of CA, thromboembolism (TE) remains one of the most feared periprocedural complications. Minimizing the risk of TE during and after CA requires a multifaceted approach, in which periprocedural anticoagulation plays a central role. The goal of anticoagulation before, during, and after CA is to minimize TE risk without excessively increasing the risk of adverse bleeding. Generally, there are two broad approaches to periprocedural anticoagulation management, “interrupted” or “uninterrupted.” Interrupted refers to those patients in whom their oral anticoagulant is stopped before the CA, with or without “bridging” with another anticoagulant, while uninterrupted refers to continuation of oral anticoagulation throughout the periprocedural period. The strongest evidence supports an uninterrupted oral anticoagulation strategy with warfarin, which is currently the standard of care. The introduction of the novel anticoagulants has added some complexity to the decision making. Current data generally supports that these are safe to use and are not associated with any additional procedural risk or adverse events (thromboembolism or bleeding) compared to warfarin. At present, based upon current evidence from randomized trials, dabigatran and rivaroxaban are reasonable alternatives to warfarin for an uninterrupted approach, while further data is needed (and trials are ongoing) for apixaban and edoxaban. In this article, we discuss the different approaches to the management of periprocedural anticoagulation and the data supporting their use.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, 200 1st Street SW, Rochester, MN, USA

    Alan Sugrue MB BCh, MSc, MRCPI & Peter A. Noseworthy MD

  2. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA

    Konstantinos C. Siontis MD

  3. Duke University Medical Center Duke Clinical Research Institute Durham, Durham, NC, USA

    Jonathan P. Piccini MD

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  1. Alan Sugrue MB BCh, MSc, MRCPI
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  2. Konstantinos C. Siontis MD
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  3. Jonathan P. Piccini MD
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  4. Peter A. Noseworthy MD
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Correspondence to Peter A. Noseworthy MD.

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This article is part of the Topical Collection on Arrhythmia

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Sugrue, A., Siontis, K.C., Piccini, J.P. et al. Periprocedural Anticoagulation Management for Atrial Fibrillation Ablation: Current Knowledge and Future Directions. Curr Treat Options Cardio Med 20, 3 (2018). https://doi.org/10.1007/s11936-018-0600-8

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