Pulmonary Vein Isolation with Recent Coronary Stent

A 63-year-old woman is booked for a pulmonary vein isolation for atrial fibrillation today. She is scheduled to be the first case on your afternoon list in the cardiac catheter laboratory. She describes episodic palpitations lasting 30 to 40 minutes up to five times a day with associated fatigue and exertional limitation. Past medical history: Ischaemic heart disease – drug-eluting stent (DES) to proximal LAD 12 weeks ago for stable angina symptoms Hypertension Type 2 diabetes mellitus Obstructive sleep apnoea requiring nocturnal CPAP Elevated BMI (41 kg/m2) Chronic kidney disease - baseline eGFR 65 mL/min/1.73m2 Current medications: apixaban 5 mg bd aspirin 100 mg daily clopidogrel 75 mg daily dapagliflozin 5 mg daily bisoprolol 2.5 mg bd insulin glargine 20 units nocte subcutaneously irbesartan/hydrochlorothiazide 150 mg/12.5 mg daily pantoprazole 40 mg daily rosuvastatin 10 mg nocte An ECG has been taken this morning. Her blood pressure is 118/79 mmHg and SpO2 98% (room air).