Atrial fibrillation (AF) is a cause of significant morbidity and mortality.
Catheter ablation for AF (
CAAF) has emerged as an effective treatment option of rhythm control for patients with symptomatic AF. However, the risk of
thromboembolism and
bleeding in the periprocedural period represent a worrisome complication of this
therapy. The reported incidence of thromboembolic and
bleeding events associated with
CAAF varies from 0.9% to 5% depending on the
CAAF strategy and the anticoagulation regimen used in the periprocedural period. Areas covered: The different anticoagulation regimens used prior to, during, and after
CAAF to minimize the risk of thromboembolic and
bleeding events are reviewed. The use of uninterrupted oral anticoagulation and appropriate
heparin dosing to achieve safe activated clotting time levels are also detailed. A comprehensive approach with assessment of individual risk for thromboembolic and
bleeding complications, and understanding the pharmacokinetics of the
anticoagulant agents available is also reviewed. Expert opinion: The key advances done in the periprocedural anticoagulation field include the use of uninterrupted anticoagulation strategies in patients undergoing AF ablation and efforts to simplify the selection of patients who need LAA
thrombus screening prior to ablation.