Anticoagulation Management Pre- and Post Atrial Fibrillation Ablation: A Survey of Canadian Centres

Background Anticoagulation in patients undergoing atrial fibrillation (AF) ablation is crucial to minimize the risk of thromboembolic complications. There are broad ranges of approaches to anticoagulation management pre and post AF ablation procedures. The purpose of this study was to determine the anticoagulation strategies currently in use in patients peri- and post AF ablation in Canada. Methods A Web-based national survey of electrophysiologists performing AF ablation in Canada collected data regarding anticoagulation practice prior to ablation, periprocedural bridging, and duration of postablation anticoagulation. Results The survey was completed by 36 (97%) of the 37 electrophysiologists performing AF ablation across Canada. Prior to AF ablation, 58% of electrophysiologists started anticoagulation for patients with paroxysmal AF CHADS 2 scores of 0 to 1, 92% for paroxysmal AF CHADS 2 scores ≥ 2, 83% for persistent AF CHADS 2 scores of 0 to 1, and 97% for persistent AF CHADS 2 scores ≥ 2. For patients with CHADS 2 0 to 1, warfarin was continued for at least 3 months by most physicians (89% for paroxysmal and 94% for persistent AF). For patients with CHADS 2 ≥ 2 and with no recurrence of AF at 1 year post ablation, 89% of physicians continued warfarin. Conclusions Although guidelines recommend long-term anticoagulation in patients with CHADS 2 ≥ 2, 11% of physicians would discontinue warfarin in patients with no evidence of recurrent AF 1 year post successful ablation. Significant heterogeneity exists regarding periprocedural anticoagulation management in clinical practice. Clinical trial evidence is required to guide optimal periprocedural anticoagulation and therapeutic decisions regarding long-term anticoagulation after an apparently successful catheter ablation for AF.