What is the standard anticoagulation approach around AF ablation?

• A. Maintain therapeutic anticoagulation, typically uninterrupted if on warfarin; use IV heparin during the procedure to keep ACT > 300 s; generally continue anticoagulation for 2–3 months post-ablation
• B. Stop all anticoagulation before procedure
• C. Start anticoagulation only after procedure
• D. Use antiplatelet therapy only

Answer: (A)

Maintaining anticoagulation around AF ablation is about preventing clots during a period of endothelial irritation and catheter manipulation while keeping bleeding risk in check. If a patient is on warfarin, the standard approach is to continue it without interruption through the procedure. During the ablation, IV heparin is given and the activated clotting time is kept above roughly 300 seconds to ensure sufficient anticoagulation in real time and reduce the chance of thrombus formation on catheters or in the left atrium. After the procedure, anticoagulation is generally continued for about 2–3 months to cover the healing period, when the risk of thromboembolism remains elevated due to atrial stunning and ablation-induced injury. This approach balances preventing strokes with bleeding risk, and is preferred over stopping anticoagulation or relying on antiplatelet therapy alone around the procedure.