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(Circulation. 2007;116:2517-2519.)
© 2007 American Heart Association, Inc.

Editorial

Ablation for Atrial Fibrillation

Can We Decrease Thromboembolism Without Increasing the Risk for Bleeding?

Samuel J. Asirvatham, MD

From the Department of Medicine, Division of Cardiology, Mayo Clinic, Rochester, Minn.

Correspondence to Dr Samuel J. Asirvatham, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905. E-mail asirvatham.samuel@mayo.edu

Key Words: Editorials • ablation • fibrillation • fibrinogen • thrombus

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Stroke is one of the most feared untoward sequelae associated with atrial fibrillation (AF) ablation procedures, whereas bleeding is the most common.^1,2 We typically explain to patients that intensive anticoagulation during ablation is necessary to decrease the likelihood of stroke, even though some increase in bleeding and vascular complications will occur. In the present issue of Circulation, Wazni et al³ report performing AF ablation in patients with a therapeutic International Normalized Ratio (INR) and successfully decreasing thromboembolism without increasing the risk of bleeding.

Article p 2531

The hitherto standard approach taken by most ablationists is to discontinue Coumadin for 3 to 5 days before ablation and proceed after normalization of the INR. Although simple, 3 issues require attention with this approach. First, in the period when the patient is off warfarin to prevent thrombus formation, low molecular weight heparin is administered. This approach is generally successful because, when transesophageal and/or intracardiac echocardiography is performed just before left atrial ablation, only rarely is thrombus found. Second, a more difficult issue is reanticoagulation after ablation where there may be periods of inadequate anticoagulation, which allows thrombus to occur. Third, heparin used as a bridge postablation has a higher propensity to promote postprocedural bleeding than warfarin itself.⁴ Wazni et al suggest the solution of simply continuing warfarin and obviating the need to address the above problems.³

Does their approach allow the brinkmanship necessary to resolve this dilemma by simultaneously decreasing thrombotic and hemorrhagic risk, and should AF ablation be performed with a . . . [Full Text of this Article]