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Anticoagulant Strategies for Electrophysiology Procedures

  • Stuart J. Beldner
  • David L. Stern
Chapter

Abstract

Electrophysiology procedures, including direct current cardioversion, catheter ablation, and implantation of devices, e.g., pacemakers, defibrillators, and left atrial appendage closure devices, carry dual risks of bleeding and thromboembolism. Many patients undergoing these procedures are maintained on anticoagulation with either warfarin or one of several direct oral anticoagulants, e.g., dabigatran, rivaroxaban, apixaban, and edoxaban. There are evidence-based periprocedural and post-procedural guidelines for anticoagulation, with the stated goals of minimizing thromboembolic risk and minimizing bleeding complications. For example, such evidence was provided in the BRUISE CONTROL trial where it was demonstrated that continuing oral anticoagulation rather than bridging to therapy with heparin reduced the incidence of clinically significant device-pocket hematoma. The ACUTE trial established transesophageal echocardiogram (TEE) and short-term anticoagulation as an alternative to therapeutic anticoagulation with dose-adjusted warfarin for 3 weeks prior to and 4 weeks post-cardioversion. Left-sided ablation procedures are typically done with heparin boluses and infusion with target ACTs of anywhere from 250 to 350 s, with the higher targets for those procedures where catheters dwell in the left atrium.

Keywords

Ablation Cardioversion Electrophysiology Implantable cardioverter-defibrillator Pacemaker Procedural anticoagulation 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of CardiologyNorthwell Health, Zucker School of Medicine at Hofstra/NorthwellManhassetUSA

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