Anticoagulation during atrial fibrillation ablation periprocedural period- an update.
Cezary Maciejewski 1  
,   Michał Peller 1  
,   Marcin Grabowski 1  
,   Pawel Balsam 1  
,   Izabela Sierakowska 1  
,   Diana Wiewiór 1  
,   Natalia Roman 1  
,   Piotr Lodziński 1  
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I Cardiology Clinic, Medical University of Warsaw
Cezary Maciejewski   

I Cardiology Clinic, Medical University of Warsaw
Publication date: 2020-02-06
Heart Beat 2019;4:60–65
Atrial fibrillation (AF) is the most common arrhythmia diagnosed in clinical practice and often treated with pulmonary veins isolation (PVI). This procedure has both high bleeding and thromboembolic risk therefore well evidenced anticoagulation protocols are important. Anticoagulation strategy in patients undergoing PVI is described 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). Uninterrupted and interrupted anticoagulation strategies with NOACs were studied and brought conflicting results. “Dabigatran bridge” strategy for PVI was tested. New knowledge on occurrence and clinical significance of silent brain ischemia lesions after PVI was described. Alternative heparin dosing strategy during PVI in patients on NOACs was proposed.