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Table 4. Anticoagulation Strategies: Pre-, During, and Post-
Catheter Ablation of AF
Recommendations COR LOE
Preablation For patients undergoing AF catheter
ablation who have been therapeutically
anticoagulated with warfarin or
dabigatran, performance of the ablation
procedure without interruption of
warfarin or dabigatran is recommended.
1 A
For patients undergoing AF catheter
ablation who have been therapeutically
anticoagulated with rivaroxaban,
performance of the ablation procedure
without interruption of rivaroxaban is
recommended.
I B-R
For patients undergoing AF catheter
ablation who have been therapeutically
anticoagulated with a NOAC other
than dabigatran or rivaroxaban,
performance of the ablation procedure
without withholding a NOAC dose is
reasonable.
2A B-NR
Anticoagulation guidelines that pertain
to cardioversion of AF should be
adhered to in patients who present for
an AF catheter ablation procedure.
1 B-NR
For patients anticoagulated with a
NOAC prior to AF catheter ablation,
it is reasonable to hold one to two doses
of the NOAC prior to AF ablation with
reinitiation postablation.
2A B-NR
Performance of a transesophageal
echocardiogram (TEE) in patients
who are in AF on presentation for
AF catheter ablation and have been
anticoagulated therapeutically for 3
weeks or longer is reasonable.
2A C-EO
Performance of a TEE in patients who
present for ablation in sinus rhythm and
who have not been anticoagulated prior
to catheter ablation is reasonable.
2A C-EO
Use of intracardiac echocardiography to
screen for atrial thrombi in patients who
cannot undergo TEE may be considered.
2B C-EO
