Atrial fibrillation ablation

Ablazione della fibrillazione atriale

Abstract

Transcatheter ablation can be used in case of atrial fibrillation (AF) not controlled by medical therapy due to lack of efficacy or poor tolerability.The procedure is however associated with the risk of periprocedural events and therefore requires particular attention to systemic anticoagulant therapy. In this clinical setting dabigatran may represent a valid therapeutic option to ensure adequate patient protection during the ablation procedure, as demonstrated by the results of the RE-CIRCUIT study. Here we describe an elderly patient, treated for hypertension, with a slightly impaired renal function, a long history of highly symptomatic paroxysmal AF resistant to antiarrhythmic drugs. It describes the common clinical practice prior to the publication of the RE-CIRCUIT study results, which support performing the AF ablation procedure without interrupting the anticoagulant therapy in place with dabigatran. It also highlights the potential efficacy of dabigatran in the treatment of endoauricular thrombus in patients with FA, for whom the currently recommended treatment is bridging with LMWH and the initiation of oral anticoagulant therapy with VKA, which however may be ineffective, as in this case (Diabetology).