Thromboembolic risk and anticoagulation strategies in patients undergoing catheter ablation for atrial fibrillation

Abstract

Periprocedural thromboembolic and hemorrhagic events are complications of percutaneous radiofrequency catheter ablation (RFA) of atrial fibrillation (AF). The management of anticoagulation before and after RFA could play an important role in the prevention of these complications. The incidence of thromboembolic events varies from 1% to 5%, depending on the ablation and the anticoagulation strategy used in the periprocedural period. The scientific evidence behind the management of anticoagulation in patients with AF undergoing RFA is scarce and is mostly based on small studies and experts' consensus. It remains unclear whether catheter ablation for AF reduces the risk of stroke and obviates the need for anticoagulation after the procedure. Limited data are available regarding the risk of thromboembolism with and without warfarin after AF ablation. In this review we will review the most current evidence supporting the different strategies to reduce thromboembolic risk before, during, and after catheter ablation for AF.