Ablation for atrial fibrillation: can we decrease thromboembolism without increasing the risk for bleeding?

Stroke is one of the most feared untoward sequelae associated with atrial fibrillation (AF) ablation procedures, whereas bleeding is the most common.1,2 We typically explain to patients that intensive anticoagulation during ablation is necessary to decrease the likelihood of stroke, even though some increase in bleeding and vascular complications will occur. In the present issue of Circulation, Wazni et al3 report performing AF ablation in patients with a therapeutic International Normalized Ratio (INR) and successfully decreasing thromboembolism without increasing the risk of bleeding.