More than 150, 000 patients undergo ablation for atrial fibrillation each year. Current guidelines recommend oral anticoagulation in all patients undergoing AF ablation. A large number of patients undergoing cardiac implantable electronic devices (CIED) are on long term oral anticoagulation. These patients are at increased risk for thromboembolism with interruption of oral anticoagulation. However because of the increased procedural risk for bleeding complications, balancing the need to prevent thromboembolism can be challenging during the periprocedural management of anticoagulation in these patients. In this article we review the current evidence for periprocedural management of oral anticoagulation in patients undergoing ablation and CIED implantation.