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Updated: Feb 21, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Peri-interventional combined anticoagulation and antithrombotic therapy in atrial fibrillation ablation: A
Katharina Klee1, Daniel Widulle, Martin Duckheim
1Kardiologie, Eberhard-Karls- Universität, Ottfried-Müller-Straße 10, 72076 Tübingen, Germany. katharina.klee@med.uni-tuebingen.de.
Insights
Additional antiplatelet therapy increases bleeding risk during catheter ablation for atrial fibrillation. Discontinuing antiplatelet treatment before ablation may reduce severe femoral bleeding events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Catheter ablation (CA) for atrial fibrillation (AF) necessitates anticoagulation to prevent thromboembolic events.
- Patients with coronary artery disease often require antiplatelet therapy (AAT) post-intervention, raising concerns about bleeding risk during AF ablation.
Purpose of the Study:
- To investigate the peri-interventional bleeding risk in patients undergoing catheter ablation for atrial fibrillation who are also on antiplatelet therapy.
Main Methods:
- Retrospective analysis of 1235 patients undergoing CA for AF.
- Bleeding events classified using the BARC classification.
- Comparison of bleeding rates between patients on anticoagulation alone versus those on anticoagulation plus AAT.
Main Results:
- No significant difference in minor bleeding (Type 1) or tamponades (Type 3b).
- Significantly higher rates of severe femoral bleeding (Type 2/3a) in patients on AAT (7.5% vs. 3.2%, p=0.006).
Conclusions:
- Antiplatelet therapy elevates the risk of severe femoral bleeding during AF catheter ablation.
- Consider discontinuing AAT before elective AF ablation to mitigate bleeding complications.
Background:
Catheter ablation (CA) of atrial fibrillation (AF) requires an intensified peri-inter-ventional anticoagulation scheme to avoid thromboembolic complications. In patients with cardiac or extracardiac artery disease, an additional antiplatelet treatment (AAT) is at least temporally necessary especially after a percutaneous intervention with stent implantation. This raises the question whether these patients have a higher peri-interventional bleeding risk during CA of AF.
Methods:
The data of 1235 patients with CA of AF were retrospectively analyzed in terms of bleeding events, ablation type, antithrombotic medication and comorbidities such as coronary artery disease and components of the HAS- BLED score. Peri-interventional bleeding events were classified in accordance with the BARC classification. Differentiations were made between slight femoral bleeding (based on type 1), severe femoral bleeding and pericardial effusion without pericardiocentesis (based on type 2) with the need of further hospitalization, the need of transfusion (based on type 3a) and pericardial tamponades requiring pericardiocentesis (based on type 3b).
Results:
1131/1235 (91.6%) patients were exclusively under anticoagulation and 187 (15.3%) patients were also on AAT. There were no statistically significant differences in type 1 and 3b bleeding complica-tions or the occurrence of femoral pseudoaneurysms between both groups. However, type 2/3a bleeding complications, mostly femoral bleedings, were significantly more frequent in the patient group with AAT (3.2% vs. 7.5%, p = 0.006).
Conclusions:
An additional antiplatelet therapy increases the risk of severe femoral bleeding events during CA of AF. It appears reasonable to perform the elective procedure of AF ablation after the dis-continuation of AAT.
