Successful use of bivalirudin in place of heparin infusion for pulmonary vein isolation using a cryoballoon catheter in a patient with heparin allergy

Current guidelines recommend using bivalirudin as an alternative to unfractionated heparin in patients with heparin-induced thrombocytopenia undergoing percutaneous coronary intervention (PCI). Pulmonary vein isolation (PVI) is a well-established treatment strategy for patients with drug-refractory atrial fibrillation (AF) and requires systemic anticoagulation to avoid thromboembolic events, generally achieved with intravenous unfractionated heparin. There are several reports in the literature of bivalirudin use in place of unfractionated heparin during PVI with radiofrequency (RF) energy in patients with heparin-induced thrombocytopenia. To our knowledge, this is the first report of the safe use of bivalirudin for PVI using a cryoballoon catheter.