Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment

Abstract

Current guidelines recommend discontinuation of oral anticoagulation treatment (OAT) and switch to heparin 2–5 days before catheter ablation of atrial fibrillation (AF). However, increasing evidence leans against the ‘bridge therapy’ and support continuation of OAT during the procedure. We evaluated the safety of AF ablation among patients with therapeutic OAT. The study population comprised 193 consecutive patients who underwent 228 AF ablation procedures guided by electroanatomical mapping. Periprocedural international normalized ratio was P = 1.0) and minor complications (P = 0.74) between the groups. The bleeding complications included one surgically corrected groin haematoma in both groups (0.9%), 25 small haematomas at the puncture site (11 in Group 1 (10.7%) and 14 in Group 2 (11.2%), P = 0.90), and two minor pericardial effusions in Group 1. In Group 2, one patient had ischaemic stroke 16 days after the procedure. Transseptal puncture and AF ablation can be performed safely in patients with ongoing OAT without intracardiac echocardiographic guidance and ACT monitoring.