TY - JOUR
T1 - Anticoagulation during AF ablation
T2 - The balance between thromboembolism and bleeding
AU - Mears, Jennifer A.
AU - Asirvatham, Samuel J.
PY - 2009/2
Y1 - 2009/2
N2 - Radiofrequency ablation for atrial fibrillation is being increasingly used to treat patients with symptomatic arrhythmia. The procedure is complex and associated with significant complications including thromboembolism, stroke, and bleeding. Despite significant advances in catheter design, online cardiac imaging, and greater operator experience, both stroke and major vascular complications continue to be problematic. Increasing the duration and intensity of anticoagulation has been the primary modality used to decrease thromboembolism. However, these measures increase the likelihood and severity of bleeding-related complications. The optimal method of anticoagulation along with the adjunctive use of technology to decrease vascular complications and mechanically prevent cerebral embolization is unknown. In this paper, we review the present methods used by ablationists to decrease the likelihood of thromboembolism during atrial fibrillation. We then describe methods used to decrease bleeding and vascular complications at access sites as well as cardiac perforation. We briefly discuss newer techniques to decrease endovascular complications including epicardial ablation and the use of temporarily implanted vascular protection devices. Finally, we describe the best option or combination of approaches that attempt to balance the risks of thromboembolism and bleeding during AF ablation.
AB - Radiofrequency ablation for atrial fibrillation is being increasingly used to treat patients with symptomatic arrhythmia. The procedure is complex and associated with significant complications including thromboembolism, stroke, and bleeding. Despite significant advances in catheter design, online cardiac imaging, and greater operator experience, both stroke and major vascular complications continue to be problematic. Increasing the duration and intensity of anticoagulation has been the primary modality used to decrease thromboembolism. However, these measures increase the likelihood and severity of bleeding-related complications. The optimal method of anticoagulation along with the adjunctive use of technology to decrease vascular complications and mechanically prevent cerebral embolization is unknown. In this paper, we review the present methods used by ablationists to decrease the likelihood of thromboembolism during atrial fibrillation. We then describe methods used to decrease bleeding and vascular complications at access sites as well as cardiac perforation. We briefly discuss newer techniques to decrease endovascular complications including epicardial ablation and the use of temporarily implanted vascular protection devices. Finally, we describe the best option or combination of approaches that attempt to balance the risks of thromboembolism and bleeding during AF ablation.
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U2 - 10.4022/jafib.v1i5.522
DO - 10.4022/jafib.v1i5.522
M3 - Review article
AN - SCOPUS:77951123618
SN - 1941-6911
VL - 1
SP - 285
EP - 297
JO - Journal of Atrial Fibrillation
JF - Journal of Atrial Fibrillation
IS - 5
ER -