Key result
High-concentration heparinized saline perfusion during AF ablation is linked to a ~0.21% thromboembolic complication rate.
Why the study?
Transseptal catheterization for AF ablation carries a risk of thromboembolism, prompting investigation into the safety and effectiveness of a simple transseptal sheath management protocol to reduce sheath-associated thrombus.
Does transseptal sheath perfusion with high concentration heparinized saline prevent sheath-associated thrombus and thromboembolic complications in AF patients undergoing radiofrequency ablation?
Observational (n=4,765)
Yes
Does transseptal sheath perfusion with high concentration heparinized saline prevent sheath-associated thrombus and thromboembolic complications in AF patients undergoing radiofrequency ablation?
Perfusion of transseptal sheaths with high-concentration heparinized saline is a safe and effective strategy to minimize sheath-associated thrombus and thromboembolic risk during AF ablation.
Answers are grounded in this paper and cite their sources.
Low thromboembolic rates with high-concentration heparin perfusion support its consideration in AF ablation; hypothesis-generating and leaves open randomized confirmation.
BACKGROUND: Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated. METHODS: AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal. RESULTS: A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies. CONCLUSION: For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.
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Xu et al. (2024) conducted an observational in Atrial fibrillation (n=4,765). Transseptal sheath perfused with high concentration heparinized saline was evaluated on Perioperative thromboembolic complications. Transseptal sheath perfusion with high concentration heparinized saline (20 u/mL) during AF ablation resulted in a low rate of perioperative thromboembolic complications (0.21% of patients).
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