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August 2017 Br J Cardiol 2017;24:90–2 doi:10.5837/bjc.2017.022

Are NOACs safe in catheter ablation of atrial fibrillation?

Adam J Graham, Richard J Schilling

Abstract

Figure 1. Mechanisms of coagulation during catheter ablation of atrial fibrillation (AF) and sites of action for non-vitamin K antagonist oral anticoagulants (NOACs) So how do we mitigate the thromboembolic risk during catheter ablation? Intravenous (IV) heparin is used with an activated clotting time (ACT) target of >300 s during the procedure and the use of saline-irrigated catheters seems to reduce risk further by decreasing the incidence of emboli from the catheter tip.3 Guidelines currently recommend oral anticoagulation three to four weeks before ablation,2,4 but there remains some debate about the management of oral anticoagulation

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