Peri-Procedural Management of Novel Oral Anticoagulants in Catheter Ablation of Atrial Fibrillation

A 73-year-old man with persistent atrial fibrillation (AF), hypertension, and heart failure is seen for consideration of AF catheter ablation. He has no other significant past history. He is felt to have a reduced ejection fraction due to tachycardia-induced cardiomyopathy. Attempts at a rate control strategy were unsuccessful, with ongoing symptoms of exertional dyspnea. Attempts at amiodarone-facilitated electrical cardioversion were transiently successful with resolution of symptoms during sinus rhythm.

He is anticoagulated with dabigatran 150 mg by mouth twice daily due to patient preference. He is due to undergo AF catheter ablation in two weeks. His creatinine is 0.9 mg/dL with an estimated creatinine clearance of 97 mL/min.

What is the best strategy for peri-procedural anticoagulation for AF catheter ablation in this patient?

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