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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.


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


Hugh Calkins
John Hopkins Hospital, Maryland, USA