5.3 Anticoagulation
Previous studies reported that continuation of anticoagulation in peri-operative period can reduce ischemic complication after RFCA.19, 20 However, pre- or post-RFCA anticoagulation did not affect the incidence of peri-procedural ischemic complication in our study. Since embolic material formed by catheter ablation is mainly consisted of denaturized and aggregated proteins rather than classical thrombus, peri-procedural ischemic complication can still occur despite optimal anticoagulation therapy.9 Indeed, heat induced protein denaturation and aggregation occurred independently from heparin concentration.9Nevertheless, optimal anticoagulation therapy should be done in peri-procedural period since denaturized material formed by radiofrequency energy can activate coagulation cascade. Both irrigation and anticoagulation are essential.