12
Treatment
During ablation Heparin should be administered prior
to or immediately following transeptal
puncture during AF catheter ablation
procedures and adjusted to achieve and
maintain an activated clotting time
(ACT) of at least 300 seconds.
1 B-NR
Administration of protamine following
AF catheter ablation to reverse heparin
is reasonable.
2A B-NR
Postablation In patients who are not therapeutically
anticoagulated prior to catheter ablation
of AF and in whom warfarin will be used
for anticoagulation postablation, low
molecular weight heparin or intravenous
heparin should be used as a bridge for
initiation of systemic anticoagulation
with warfarin following AF ablation.
1 C-EO
Systemic anticoagulation with warfarin
or a NOAC is recommended for at least
2 months postcatheter ablation of AF.
1 C-EO
Adherence to AF anticoagulation
guidelines is recommended for patients
who have undergone an AF ablation
procedure, regardless of the apparent
success or failure of the procedure.
1 C-EO
Decisions regarding continuation of
systemic anticoagulation more than 2
months postablation should be based on
the patient's stroke risk profile and not
on the perceived success or failure of the
ablation procedure.
1 C-EO
In patients who have not been
anticoagulated prior to catheter ablation
of AF or in whom anticoagulation with a
NOAC or warfarin has been interrupted
prior to ablation, administration of a
NOAC 3 to 5 hours aer achievement
of hemostasis is reasonable postablation.
2A C-EO
Patients in whom discontinuation of
anticoagulation is being considered
based on patients values and preferences
should consider undergoing continuous
or frequent ECG monitoring to screen
for AF recurrence.
2B C-EO
Table 4. Anticoagulation Strategies: Pre-, During, and Post-
Catheter Ablation of AF (cont'd)
Recommendations COR LOE
