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he number of patients undergoing catheter ablation for atrial fibrillation (AF) has been increasing year by year. As noted in the updated guideline (ACC/AHA/ ESC) for the management of patients with AF,1 embolic stroke is one of the most serious complications of AF ablation procedures. A higher intensity of anticoagulation is required to reduce the risk of thrombus formation during ablation. The recent 2012 HRS/EHRA/ECAS expert consensus statement notes that uninterrupted warfarin is a potential alternative to bridging with low-molecular-weight heparin.2 In fact, in Japan, most of the large-volume centers adopt continuation of periprocedural warfarin in the therapeutic range. However, warfarin takes a long time to reach to its therapeutic range and there are some patients in whom it is difficult to control warfarin within the therapeutic range. Dabigatran, an oral direct thrombin inhibitor, was recently approved for the prevention of embolic stroke in patients with nonvalvular AF.3 Therefore, there has been an interest in taking advantage of dabigatran around the time of catheter ablation. Three reports that evaluated the safety of periprocedural use of dabigatran for AF ablation in comparison with warfarin have been recently published.4–6

Can Dabigatran Be an Alternative Periprocedural Anticoagulation for Atrial Fibrillation Ablation?