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Catheter ablation therapy for atrial fibrillation (AF) is a safe and effective treatment for patients with both paroxysmal and persistent symptomatic AF. However, given the uncertainty about recurrence after the ablation procedure and continued risk of thromboembolism, it is still recommended to treat with anticoagulation for the long-term prevention of stroke. Left atrial appendage (LAA) occlusion with the WATCHMAN device (Boston Scientific Corp., Natick, MA) has demonstrated equivalent reduction in stroke compared to warfarin as well as a mortality benefit in patients with AF and CHADS2VASC2 score 41, 1,2 and it is increasingly being used as an alternative to warfarin for long-term prevention of stroke. A short-term requirement for antithrombotic therapy remains for 6 months while the device develops an endothelial layer. Recently, some centers have begun to perform concomitant catheter ablation and WATCHMAN LAA occlusion. This strategy has the benefit of providing treatment for symptomatic AF as well as stroke prevention without the need for long-term anticoagulation. However, there are currently no established guidelines for the type and duration of short-term antithrombotic therapy necessary to prevent device-related thrombosis (DRT) and stroke. Current antithrombotic strategies in studies involving concomitant AF ablation and WATCHMAN LAA occlusion are based on a combination of the HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of AF and the PROTECT AF trial protocol. These studies use differing antithrombotic strategies, however. Given the numerous strategies used for anticoagulation in this emerging procedure, it is possible, or even expected, that

heartrhythm case reports

Termination of anticoagulation therapy at 45 days after concomitant atrial fibrillation catheter ablation and left atrial appendage occlusion resulting in device-related thrombosis and stroke