Anticoagulation during atrial fibrillation ablation periprocedural period- an update.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice and is often treated with pulmonary vein isolation (PVI). This procedure has both high bleeding and thromboembolic risk; therefore well evidenced anticoagulation protocols are important. The anticoagulation strategy in patients undergoing PVI is described in the Expert Consensus. We analyzed studies released after 2018 pertaining to anticoagulation during PVI. Different anticoagulation approaches for AF ablation were studied. New evidence on edoxaban and apixaban for PVI emerged. Direct oral anticoagulants (DOACs) seemed to be safer in terms of bleeding risk and equally effective in stroke prevention compared to vitamin K antagonists (VKAs) according to one metanalysis. Uninterrupted and interrupted anticoagulation strategies with novel oral anticoagulants (NOACs) were studied and brought conflicting results. The "dabigatran bridge" strategy for PVI was tested. New knowledge on the occurrence and clinical significance of silent brain ischemic lesions after PVI is described. An alternative heparin dosing strategy during PVI in patients on NOACs was proposed.