Safety of pulmonary vein isolation in atrial fibrillation patients treated with dabigatran when idarucizumab is available (RCDD code: VIII)

Edward Koźluk, Dariusz Rodkiewicz, Agnieszka Piątkowska, Paweł Tomasz Matusik, Grzegorz Opolski

Full Text:



Patients with atrial fibrillation (AF) are at increased risk of stroke and systemic thromboembolism and prevention of such episodes is ensured by choosing appropriate anticoagulation. In paroxysmal drug‐refractory AF, catheter ablation is the recommended choice of treatment. The decision on whether to stop administration of oral anticoagulant before catheter ablation procedures is often unclear. We present the case of a 67‐year‐old hypertensive woman with a 5‐year history of symptomatic, drug‐refractory paroxysmal AF, who was admitted for pulmonary vein isolation (PVI) and was anticoagulated with dabigatran. After successful transseptal puncture, an intravenous injection of 10 000 units of heparin was administered. Radiofrequency ablation was initiated at the left pulmonary trunk. After the second application of radiofrequency ablation, a drop in arterial blood pressure to 70/50 mmHg was observed. Urgent echocardiography revealed the presence of fluid within the epicardial surface of the left ventricular apex up to 19 mm, behind the right ventricle and right atrium up to 11 mm. Subsequently, all catheters were removed from the left atrium, and 50 mg of protamine sulfate, dopamine, and intravenous fluids were immediately administered. Idarucizumab was urgently delivered to the catheterisation laboratory and was available during patient hospitalisation in the intensive care unit. However, prior to patient discharge, echocardiography revealed only a trace amount of fluid in the pericardium and the use of idarucizumab was not indicated. Interruption of anticoagulation treatment with dabigatran before ablation is not required. Idarucizumab increases the safety of PVI in patients treated with dabigatran. JRCD 2018; 3 (8): 281–283


rare disease; atrial fibrillation; ablation; pulmonary vein isolation; anticoagulation; dabigatran


Prystowsky EN, Padanilam BJ, Fogel RI. Treatment of Atrial Fibrillation. JAMA 2015; 314: 278-288.

Matusik PT, Prior SM, Butenas S, et al. Association of cardiac troponin I with prothrombotic alterations in atrial fibrillation. Kardiol Pol 2018; 76: 1106-1109.

Kirchhof P, Benussi S, Kotecha D, et al. [2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS]. Kardiol Pol 2016; 74: 1359-1469.

Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace 2018; 20: 157-208.

Kuck KH, Brugada J, Furnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med 2016; 374: 2235-2245.

Matusik P, Lelakowski J, Malecka B, et al. Management of Patients with Atrial Fibrillation: Focus on Treatment Options. J Atr Fibrillation 2016; 9: 1450.

Steffel J, Verhamme P, Potpara TS, et al. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J 2018; 39: 1330-1393.

Calkins H, Willems S, Gerstenfeld EP, et al. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation. N Engl J Med 2017; 376: 1627-1636.

Baglin T, Hillarp A, Tripodi A, et al. Measuring Oral Direct Inhibitors (ODIs) of thrombin and factor Xa: A recommendation from the Subcommittee on Control of Anticoagulation of the Scientific and Standardisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2013.

Pollack CV, Jr., Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N Engl J Med 2015; 373: 511-520.

Connolly SJ, Milling TJ, Jr., Eikelboom JW, et al. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. N Engl J Med 2016; 375: 1131-1141.

Agosti S, Casalino L, Rocci E, et al. Successful intravenous thrombolysis for ischemic stroke after reversal of dabigatran anticoagulation with idarucizumab: a case report. J Med Case Rep 2017; 11: 224.

Belli EV, Lee T. Idarucizumab (Praxbind) for reversal of pradaxa prior to emergent repair of contained ruptured transverse arch aneurysm. Ann Card Anaesth 2017; 20: 369-371.

Gendron N, Feral-Pierssens AL, Jurcisin I, et al. Real-world use of idarucizumab for dabigatran reversal in three cases of serious bleeding. Clin Case Rep 2017; 5: 346-350.

Leitz P, Guner F, Wasmer K, et al. Data on procedural handling and complications of pulmonary vein isolation using the pulmonary vein ablation catheter GOLD(R). Europace 2016; 18: 696-701.



  • There are currently no refbacks.
Journal of Rare Cardiovascular Diseases (JRCD)
John Paul II Hospital in Kraków, 80 Prądnicka Str., 31-202 Kraków, Poland
Phone: +48 (12) 614 33 99, +48 (12) 614 34 88 Fax: +48 (12) 614 34 88
Published by SoftQ sp. z o.o.
ul. Oleandry 2, 30-063 Kraków, Poland
Phone: +48 (12) 444 1650 Fax: +48 (12) 444 1659