What studies have shown about uninterrupted warfarin and its effectiveness for catheter ablation?
Randomized trials have shown that uninterrupted warfarin is safe and superior to warfarin interruption for implantation of cardiac implantable electronic devices.7 For catheter ablation, anticoagulation guidelines pertinent to cardioversion generally apply to periprocedural anticoagulation and are detailed in a recent professional society expert consensus. In a randomized trial of 1,584 patients, uninterrupted warfarin, compared with interruption with heparin bridging, has been shown to have a lower risk of periprocedural stroke and bleeding.298 A randomized trial of uninterrupted rivaroxaban vs uninterrupted VKA in AF ablation demonstrated similar event rates in both arms.299 A similar randomized trial of uninterrupted dabigatran found that dabigatran was associated with fewer bleeding complications than uninterrupted warfarin.300 Although these studies were open-label, they strongly support the use of uninterrupted anticoagulation for electrophysiology procedures (Table 9).298-301