Non-stop dabigatran

The transcatheter ablation of atrial fibrillation (AF) is an important therapeutic option for patients with AF who need rhythm monitoring. Since the procedure is associated with the risk of thromboembolic events and bleeding, the choice of this option must take into account all possible alternatives, estimated outcomes, risks and patient preferences. We report the case of an elderly patient suffering from hypertension and dyslipidemia, without previous ischemic heart disease, with a previous episode of AF cardiovertited with class 1 antiarrhythmics and since then in treatment with flecainide and dabigatran. The patient presented with typical symptomatic atrial flutter, despite the antiarrhythmic therapy, and for which radiofrequency ablation procedure was performed without suspending dabigatran, with drug administration in the morning and evening of the exam. In line with the safety profile emerging from all trials with dabigatran, the RE-CIRCUIT study results support the preferential use of uninterrupted therapy with dabigatran compared to warfarin in patients with AF subjected to ablation: as demonstrated by this clinical case, the uninterrupted administration of dabigatran combines greater simplicity in the management of anticoagulant therapy with better control of the bleeding risk associated with the procedure, with clear advantages on clinical outcome (Cardiology).