Continuous anticoagulant therapy in catheter ablation of atrial fibrillation

Czech version

Authors: Lábrová R.; Lábr K.
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně
Published in: Kardiol Rev Int Med 2020, 22(2): 63-68

Overview

Catheter ablation of atrial fibrillation is indicated in symptomatic patients in whom antiarrhythmic therapy usually fails. The risk of thromboembolism in patients with atrial fibrillation is stratified according to the CHA₂DS₂-VASc score and anticoagulant therapy is used, either a vitamin K antagonist – warfarin, or direct anticoagulants – dabigatran, rivaroxaban, apixaban, edoxaban. Patients undergoing ablation have an increased risk of bleeding, but also a higher risk of thromboembolic events. The COMPARE study showed that continued warfarin treatment reduced bleeding and thromboembolic complications in atrial fibrillation ablation. Subsequent randomised studies with direct anticoagulants – the VENTURE AF study with rivaroxaban, the RE-CIRCUIT study with dabigatran, AXAFA-AFNET 5 with apixaban and the last published ELIMINATE AF study with edoxaban gave the same results. Thus, bridging with low molecular weight heparin is not indicated in catheter ablation of atrial fibrillation, as it involves more bleeding and thromboembolic complications. This also applies to implantations of pacemakers and defibrillators.

Keywords:

stroke – bleeding – atrial fibrillation – catheter ablation – uninterrupted anticoagulation

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