Peter Hlivák, Robert Hatala
Catheter ablation represents highly effective treatment for patients with symptomatic supraventricular or ventricular arrhythmias. It has become the treatment of choice for some type of arrhythmias. Patients undergoing this treatment are usually younger and often with no structural heart disease comparing with other interventions in cardiology. Accordingly, the issue of utmost safety plays a crucial role. Despite a relatively low complication rate during these procedures in general, thromboembolic events belong to the most feared complications of catheter ablations. They have a potential for lifelong disability, or even threat of fatal outcome. Because of this reason clinical electrophysiology pays a great attention to implementation of all measures aiming to minimize or eliminate the possibility of thromboembolic events in the whole periprocedural period. It is mandatory to individualize the risks between thromboembolism and bleeding. Risk stratification should be based on the procedure itself and the patient’s individual hazards. In general, thromboembolic risk during catheter ablation in the absence of structural heart disease is relatively low. Consequently, antithrombotic management does not need to be aggressive. In contrast, complex ablation procedures in atrial fibrillation or in the presence of structural heart disease are associated with significantly higher thromboembolisk risk. This requires the combination of complex intra and periprocedural antithrombotic management usually based on the anticoagulation therapy. The present article reviews the contemporary antithrombotic strategies in the setting of all types of ablation procedures in adults. It is very important to become familiar with its management for general cardiologists too, since in the majority of cases the ablation procedure represents only 24-72 hours “episode” comparing to several months lasting pre- and postprocedural time period.