Use of NOACs in a patient who requires an AF ablation

Join Professor John Camm and Dr Hugh Calkins for a discussion of the appropriate anticoagulation treatment plan in a patient with a long history of atrial fibrillation (and a previous cardioversion) who requires an ablation procedure.

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Hugh Calkins

John Hopkins Hospital

Maryland, USA


This case study of a 76-year-old man, filmed at ACC 2018, opens with the revelation that he is solely treated with aspirin for his long-standing atrial fibrillation. Professor Camm and Dr Calkins explore the initiation of more appropriate anticoagulation, including the importance of considering non-vitamin K oral anticoagulant (NOAC) therapy in a patient who will undergo left atrial ablation, and the appropriate timing of initiation. They also discuss the results of the RE-CIRCUIT trial, where dabigatran was compared with uninterrupted warfarin, and consider the implications of the results in this case and on clinical practice in general.

  • Target audience
    This educational activity is designed for hospitalists, haematologists, interventional cardiologists, internists/physicians, surgeons and any other healthcare professional with an interest or role in the management of patients on anticoagulation who require an atrial fibrillation ablation.
  • Learning objectives
    After completing this educational activity, participants should be able to:
    1. Describe considerations for balancing bleeding risk and stroke risk before and after atrial fibrillation (AF) ablation
    2. Recognise the value of lifelong anticoagulation after performing an AF ablation procedure
    3. Discuss the safety of non-vitamin K antagonist oral anticoagulants (NOACs) in relation to AF ablation
  • Disclosures
    Professor John Camm, St George’s University of London, London, UK
    • Advisor for: Boehringer Ingelheim, Daiichi Sankyo
    • Consultant (retained) for: Boehringer Ingelheim
    • Received honoraria from: Bayer, Daiichi Sankyo, BMS-Pfizer
    Dr Hugh Calkins, John Hopkins Hospital, Maryland, USA
    • Receipt of honoraria or consultation fees from Boehringer Ingelheim
    Staff and reviewer disclosures
    • PCM Scientific staff, and others involved with the planning, development, and review of the content for this activity have no relevant affiliations or financial relationships to disclose.
  • Funding
    This independent educational activity is supported by funding from Boehringer Ingelheim. PCM Scientific is the medical education company acting as scientific secretariat and organiser for this programme. The activity is run independently of the financial supporter and all content is created by the faculty. No funder has had input into the content of the activity.