Knots to untie: anticoagulant and antiarrhythmic therapy after ablation for atrial fibrillation

The continuation or otherwise of anticoagulant and antiarrhythmic therapy after ablation of atrial fibrillation (AF) is one of the main aspects still to be defined in the electrophysiological field. The currently available data do not allow the assumption of certain positions due to the lack of randomized studies on the subject. With regard to anticoagulant therapy, however, the suggestion of the guidelines to assess more the risk profile than the result of the ablation and consequently to prescribe anticoagulant treatment to all patients with CHADSVASc ≥2 seems acceptable. Its use in the first two or three months after the procedure appears reasonable; however, keeping in mind that the objective of this strategy is limited to the prevention of early recurrences only. More prolonged use of antiarrhythmics seems to be more promising, but further data are necessary before it can be recommended routinely. The ablation of AF is a therapy that is widely spreading and its use is continuously growing. Since it is a recently introduced method, not everything is still clear about it. The continuation or not of anticoagulant and antiarrhythmic therapy after ablation for AF is one of the main aspects yet to be defined.