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Catheter and Surgical Ablation of Atrial Fibrillation

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11 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

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