Warfarin pre- ablation

[SuzieA]

Can anyone please explain why warfarin is necessary before an ablation

[BobD Volunteer]

There are many who would say that warfarin is essential for ANYBODY with AF but that is not what you asked. The reason that ablatees must be warfarinised and with a stable INR between 2 and 3 for at least three months prior to ablation is that the procedure has the ability to cause clots to form or any existing clots to be ejected which is not a good idea. (Deliberate understatement). Also by anticoagulating for three months. the likely hood of clots forming is greatly reduced. Remember that clots are thought to form in the left atrial appendage. It is common for EPs to want their patients on warfarin for three months and then stop five days before the procedure, with the gap being filled by the patient self injecting clexane to continue the anticoagulation. Clexane is a much shorter acting anticoagulant so can be controlled much more accurately during the procedure. Preferences vary of course and there appears to be no gold standard here.

Hope that helps.

Bob

[CDreamer in reply to BobD]

Bob she posted that she had a brain bleed from Warfarin a few months ago.

[BobD Volunteer in reply to CDreamer]

Sorry to read that but it is a general question with a general answer just as yours was. We can never be specific on individual cases as we are not medics and have no case notes.

[wendyg123 in reply to BobD]

Thanks for that information, the cardiac nurse mentioned the left atrial appendage. I am a biologist and thought I had crones like my mum,nanna and aunty when I became very tired with low iron level and have 2 large files details of crones and modern treatments but after colonoscoopy & endoscope there wasno evidence but I still want my NOD2 gene tested for mutations. By chance asked nurse to take BP which was high and GP asked for ECG which showed Atrial Fibrillation. Not much as shock as Mum had it and Aunty is`94 with AF. I could have told them I knew my heart was irregular as I have done heart rate ect. with kids several times a week for years. I have a finger probe which actually shows the heart trace. Maybe it is time for me to research AF but I do have faith in this cardiologist and the nurse is great. Regards Wendy

[CDreamer]

To ensure you don't have a blood clot in the atria. It would be dangerous to put a catheter into the atria with a blood clot in it as it could dislodge it and then the possibility of a stroke would be very high.

Usually they will also give you a TOE ( trans esophagus echocardiogram) just before starting the procedure. As it may imply a small camera attached to a catheter is put into the esophagus and lowered to the level of the heart so that a check can be made to ensure there is no clot in there. You will be sedated so you will not remember anything about it. It is purely a safety check.

Most usually anyone with AF would be anti coagulated with either Wafarin or one of the new anticoagulants. You didn't specify whether or not this was the case and you were asked to change to Wafarin or if you don't take any anticoagulant? My EP wanted to perform ablation within 2 weeks and I wasn't anticoagulated so he prescribed Dabigatron because he felt there wasn't enough time to get my INR into therapeutic range. Every EP has slightly different views and there was one study that suggested that there were slightly less post ablation complications when Wafarin was the pre procedure drug.

When is your ablation due?

[SuzieA in reply to CDreamer]

Think I've typed in the wrong box. My ablation's due on 5th Dec and pre-op on the 1st. Thanks for the explanation.

[CDreamer]

I just read your previous posts Suzie. I can understand you may be concerned after your previous experiences. What exactly have you been told re advice pre ablation?

[SuzieA in reply to CDreamer]

My EP initially said to take it but neuro Dr said no so to self administer heparin after ablation but I'm worried about before.

[Rellim296]

Requirements vary. I had to stop my beta blocker before my first ablation in 2011. I wasn't on warfarin. For the second, which was three years later and at a different hospital, I had to prove an INR over 2 for four weeks and I stayed on both beta blocker and flecainide.

[SuzieA in reply to Rellim296]

Thank you

[wendyg123]

It is just to ensure that any blood clots in heart are dispered before treatment. I am on warfarin before cardioversion and do not like it as you do bleed a lot more if bramble catches you while gardening or vaginal bleeding with cycstitis is quite scary but if it stops strokes who cares! it would be good if the health care workers were a little more explanatory but they have not lived throughh it. I am still NOT on the computer which works out what warfarin I need to take. Being going to clinic from August and nurse needs to disappear next door to ask the main nurse what I should be on. Not good enough. The computer does it correctly every time quickly.Do not understand I NEED to have four good INR levels before they will put me on the list.

Regards Wendy