Prä-, peri- und postinterventionelle Antikoagulation im Rahmen der Vorhofflimmerablation

Abstract

In addition to treatment with drugs to control the rate and rhythm, the method of catheter ablation is a cornerstone in the treatment of atrial fibrillation. Another crucial part in treating patients with atrial fibrillation is an adequate oral anticoagulation. Apart from the vitamin K antagonists (VKA) phenprocoumon and warfarin, the direct oral anticoagulants (DOAC) apixaban, dabigatran and rivaroxaban have been approved for oral anticoagulation of patients with atrial fibrillation. As a result there are different potential treatment possibilities for pre-interventional, peri-interventional and post-interventional anticoagulation in the setting of catheter ablation for atrial fibrillation. Due to increasing clinical experience with DOAC and the increasing number of atrial fibrillation ablations worldwide, peri-interventional treatment strategies are continuously changing. Therefore, the current article discusses current standards and gives practical guidance.

Influence of Clinical Parameters and Anticoagulation on Intraprocedural Cerebral Microembolic Signals during Pulmonary Vein Isolation

“…Currently it is unclear, whether a prophylactic anticoagulation before the PVI procedure is recommendable for patients with a CHA 2 DS 2 -Vasc-Score of 0, paroxysmal atrial fibrillation and sinusrhythmn[ 10 ]. Other observational studies previously supported an approach of performing ablation with a therapeutic INR, which may reduce the risk of ablation-related thromboembolism in low risk patients[ 11 ].…”