PMC:6019327 / 261440-262837 JSONTXT

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with AF are at increased risk of thromboembolism during, immediately following, and for several days to months after their ablation.796,797,798,799 ACE lesions have also been observed after AF ablation.800 The prothrombotic state associated with AF ablation results in a higher, but transient, thromboembolism risk in patients with AF who were identified as low-risk before ablation. Careful attention to anticoagulation of patients before, during, and after ablation for AF is critical to avoid the occurrence of a thromboembolism event. Consensus recommendations for anticoagulation prior to, during, and following ablation are summarized in Table 4. The ablation procedure leaves patients with substantial areas of damaged LA endothelium that can become a nidus for thrombus formation. Transseptal sheath placement and insertion of electrode catheters can precipitate thrombus formation on the catheter or on or within the sheath during the procedure.768,801,802,803,804 The atrial tissue can be stunned for weeks or months postprocedure, leading to impairment of normal contraction.805 Anticoagulation, in turn, contributes to some of the most common complications of the procedure, including hemopericardium, pericardial tamponade, and vascular complications.806,807,808 Therefore, attention must be paid to achieving the optimal safe level of anticoagulation throughout the process."}