Background: Optimal periprocedural management of anticoagulation before and after atrial fibrillation (AF) ablation is necessary to prevent thromboembolism while avoiding bleeding complications. However the management of anticoagulation therapy is not uniform .The safety, efficacy and dosing of Dabigatran as an alternative anticoagulant for AF ablation remains undetermined. Methods: : Single center Observational study included 116 consecutive patients undergoing AF ablation. There were 71 males (61.2%) and 45 females (38.7%). 101 underwent Radiofrequency catheter ablation and 15 Cryo ablation. 50 patients received Dabigatran at 150 mg bid dose and 66 patients were on therapeutic INR(2.0-3.0)or bridged with Lovenox. All patients receiving dabigatran therapy who underwent AF ablation on peri procedural Dabigatran were given the last dose 24 hours prior to the procedure and restarted 6 hours after sheath removal. In the Dabigatran group, 14 (28%) were female and 36 (72%) male. Ages ranged between 32 and 75 years (average age 56.3 yrs). Average CHADS2 score was 1.06 with 49 (98%) patients out of 50 having a GFR>60 ml/min. Results: Two cases of Pericardial effusion(3.03%) needing pericardiocentesis and 2 hematomas(3.03 %) occurred in the warfarin group compared with none in the Dabigatran group. One patient had GI bleed needing transfusion with Dabigatran. No thromboembolic complications were seen in either group. Conclusion: In patients undergoing AF ablation, peri procedural Dabigatran was safe and effective in preventing thromboembolic complications as compared with uninterrupted warfarin therapy. Further evaluation and standardization of protocols will help establish the newer anticoagulants as a safe, effective and convenient therapy.
Khan, S., Duggal, M., Dunskis, P., & Bhan, A. (2013). PERIPROCEDURAL DABIGATRAN IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILLATION. Journal of the American College of Cardiology, 61(10), E401. https://doi.org/10.1016/s0735-1097(13)60401-5