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Anticoagulation for AF Ablation — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyAnticoagulation for AF AblationEECC

A 45-year-old man with paroxysmal AF on rivaroxaban is scheduled for elective catheter ablation (pulmonary vein isolation). He took his last dose of rivaroxaban this morning. What is the recommended anticoagulation strategy?

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Correct answer: B — Continue rivaroxaban uninterrupted; perform the procedure without bridging

The 2024 ESC AF Guidelines recommend an uninterrupted DOAC strategy for AF catheter ablation (Class I, LOE A), based on evidence from the VENTURE-AF and RE-CIRCUIT trials showing that uninterrupted DOAC is non-inferior to uninterrupted warfarin with lower bleeding complications. The patient should take their DOAC as normal on the morning of the procedure. During the procedure, heparin is administered to maintain ACT >300 seconds. Bridging with LMWH is not recommended as it increases bleeding risk. Post-procedure, the DOAC is resumed the same evening.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation