Experience of managing periprocedural anticoagulation in patients on dabigatran undergoing radiofrequency ablation for atrial fibrillation (AF) is lacking. This multicenter prospective registry study aimed to evaluate the feasibility and safety of continuing
dabigatran during this procedure.

The study included all consecutive patients (n= 290) from a prospective registry undergoing AF ablation in 8 high-volume centres in the US. Patients on dabigatran who underwent AF ablation on periprocedural dabigatran, with the dose held on the morning of the procedure (n= 145), were matched by age, sex, and type of AF with an equal number of patients undergoing AF ablation with uninterrupted warfarin therapy over the same period. The mean age of patients was 60 years, 79% were male and 57% had paroxysmal AF. Both groups had a similar CHADS2 score, left atrial size, and left ventricular ejection fraction.

The following findings were reported:

• Three thromboembolic complications (2.1%) occurred in the dabigatran group vs. none in the warfarin group (p =0.25).

• The dabigatran group had a higher major bleeding rate (6% vs. 1%; p=0.019), total bleeding rate (14% vs. 6%; p=0.031), and composite of bleeding and thromboembolic complications (16% vs. 6%; p =0.009) compared with the warfarin group.

• Dabigatran use was confirmed as an independent predictor of bleeding or thromboembolic complications (odds ratio: 2.76, 95% CI, 1.22 to 6.25; p=0.01) on multivariate regression analysis.

The researchers conclude that “in patients undergoing AF ablation, continuation of dabigatran during the periprocedural period is associated with an increased risk of bleeding and composite of bleeding or embolic complications compared with uninterrupted warfarin therapy. Further studies are needed to identify the optimal periprocedural anticoagulation strategies in patients on dabigatran undergoing AF ablation.”