The unfinished issue of ischaemic stroke and embolic events during ablation for atrial fibrillation: the authors' reply

We thank Dr. Providenciaet al.1 for the concern and comments on our article.2 We agree with them that discontinuation of warfarin before catheter ablation for atrial fibrillation (AF) is likely associated with increased risk of periprocedural thrombo-embolic events. We cannot comment on the effects of different periprocedural anticoagulation strategy used in our cohort on thrombo-embolic events during AF ablation because of only a small minority of patients who were anti-coagulated with uninterrupted warfarin. Although several reports indicate that AF ablation can be performed safely with fewer stroke and bleeding complications when oral warfarin is continued in the periprocedural period,3,4 it may be difficult to determine in some cases with high risk of major bleeding complications and over anticoagulation (such as the case 8 with complicated atrial tachyarrhythmia and long procedure duration) whether AF ablation without interruption of oral anticoagulation is an appropriate alternative.

Source: Europace - March 17, 2017 Category: Cardiology Source Type: research