Periprocedural care for catheter ablation of atrial fibrillation

Catheter ablation of atrial fibrillation (AF) has rapidly evolved in the last 10-15 years and is now a commonly performed ablation procedure at many medical centers. Patients have elevated thromboembolic risk during and after ablation procedures for AF, which mandates a careful periprocedural anticoagulation management. Current guidelines for AF ablation suggest an approach to anticoagulation and transesophageal echocardiography (TEE) screening that is to guide patients undergoing electrical or pharmacologic conversion of AF. Arrhythmia monitoring is important to confirm that a patient's symptoms result from AF and to determine whether a patient has paroxysmal or persistent AF that may be useful in planning ablation strategy. Optimal periprocedural care for patients undergoing AF ablation requires meticulous attention to detail and a team approach. Such protocols should be developed within an institution for best practices and a database maintained to understand procedural efficacy and to identify and mitigate potential safety issues.