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We report the case of a 56‐year‐old female who presented with symptomatic paroxysmal atrial fibrillation. Anamnestic heparin‐induced thrombocytopenia (HIT) type II was suspected, and a rapid diagnostic test showed antibodies against platelet factor 4. The heparin‐induced platelet activation‐assay was negative. Radiofrequency pulmonary vein isolation with intraprocedural anticoagulation using bivalirudin was ultimately performed. Dosing was controlled by monitoring the activated clotting time. Post‐procedural blood tests were normal. There were no thromboembolic or bleeding events. Bivalirudin is a therapeutic option for anticoagulation during pulmonary vein isolation procedures in patients with a history of HIT type II.

journal of arrhythmia

Successful intraprocedural anticoagulation with bivalirudin during pulmonary vein isolation in a patient with known heparin‐induced thrombocytopenia type II