title: Peri-procedural Anticoagulation in Catheter Ablation for Atrial Fibrillation: A Review.
abstract: Catheter ablation for rhythm control in atrial fibrillation has been recognized as an established treatment. Patients with atrial fibrillation suffer from an increased risk of thromboembolic events. Long-term stroke risk and mortality have been shown to be reduced after catheter ablation, still the procedure per se is associated with an additive peri-procedural thromboembolic risk. Maintenance of the thrombotic - bleeding equilibrium in such patients during interventional procedures is compelling. Lack of data from randomized studies along with the recent introduction of novel oral anticoagulants in clinical practice has resulted in a wide variance of antithrombotic treatment approaches. Procedural interruption of anticoagulants, switching of anticoagulation scheme (i.e. from novel oral anticoagulants to vitamin K antagonists), bridging with heparin, timing of re-initiation of therapy and/or utilization of novel oral anticoagulants have all been points of dispute. In the present review we present the available data regarding optimal peri-procedural anticoagulation strategies in patients undergoing catheter ablation for atrial fibrillation.
authors.affiliation: Department of Cardiology, "G. Gennimatas" General Hospital of Athens, 154 Mesogion ave., 115 27, Athens, Greece.
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Vrachatis
authors.affiliation: Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Kossyvakis
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.affiliation: Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.affiliation: Department of Cardiology, Medical School, Hippokration Hospital, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Theodore G
authors.initials: TG
authors.lastname: Papaioannou
authors.affiliation: Department of Internal Medicine, "G. Gennimatas" General Hospital of Athens, Athens, Greece.
authors.forename: Stamatina
authors.initials: S
authors.lastname: Pagoni
authors.affiliation: Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece.
authors.forename: Vlasios N
authors.initials: VN
authors.lastname: Pyrgakis
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, CT, United States.
authors.forename: Spyridon G
authors.initials: SG
authors.lastname: Deftereos
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation; D006801:Humans
chemical_list: D000925:Anticoagulants
keywords: NOAC; Radiofrequency; VKA; apixaban; cryoablation; dabigatran; rivaroxaban; warfarin