Catheter ablation of atrial fibrillation is associated with the potential risk of periprocedural stroke, which can range between 1% and 5%.
Peri-procedural management of antiplatelet or anticoagulation therapy at the time of device implantation remains controversial.
Use of heparin or LMWH in place of warfarin may not be advisable in device-based procedures. Implantations typically occur above the pectoral fascia and significant hematomas have been shown to occur in approximately 30% of patients managed with heparin bridging in these settings.
Patients receiving heparin after cardiac device implantation had a 5- or 10-fold greater risk of pocket hematoma formation when compared with patients treated with warfarin alone or no anticoagulation, respectively.
General Recommendations for Pre-Procedure Warfarin Management
- Cardioversion: Continue warfarin. Therapeutic INR required for 3 weeks prior to procedure (or perform TEE).
- Radiofrequency ablation: Continue warfarin OR hold warfarin/bridge with LMWH (patient and provider specific decision)
- Pacemaker and ICD placement: Continue warfarin
- Pacemaker and ICD battery change: Continue warfarin
- Angiogram/cardiac cath: Hold warfarin 3-4 days to target INR <1.5
- Cardiothoracic surgery: Hold warfarin x5 days prior to surgery