Key result
Early heparin administration before transseptal access during left atrial ablation reduced early intracardiac thrombus formation compared to administration after access (0% vs 15.4%; P=0.04).
Why the study?
Does early heparin administration before transseptal access reduce left atrial thrombus formation and CVAs in patients undergoing atrial fibrillation ablation?
Cohort (n=55)
Does early heparin administration before transseptal access reduce left atrial thrombus formation and CVAs in patients undergoing atrial fibrillation ablation?
Absolute Event Rate: 0% vs 15.4%
p-value: p=0.04
Administering heparin before transseptal access during atrial fibrillation ablation significantly reduces early left atrial thrombus formation detected by intracardiac ultrasound.
May support pre-transseptal heparin to reduce thrombus; hypothesis-generating for CVAs, needs RCT confirmation.
Objective. Despite the use of anticoagulation during left atrial (LA) ablation procedures, ischemic cerebrovascular accidents (CVAs) are recognized as a serious complication. Heparin is usually given after safe transseptal access has been obtained, resulting in a short unprotected dwell time of catheters within the LA, which may account for CVAs. We investigated the frequency of CVAs and LA thrombus formation as detected by intracardiac ultrasound (ICE) depending on the timing of heparin administration. Methods and Results. Sixty LA ablation procedures with the use of ICE were performed in 55 patients. Patients were grouped by heparin administration after (Group I, n = 13) and before (Group II, n = 47) transseptal access. Group I patients were younger (56.6 ± 13.7 versus 65.9 ± 9.9 years, P = .01); other clinical and echocardiographic characteristics did not differ between groups. Early thrombus formation was observed in 2 (15.4%) of group I patients as compared to 0% of group II patients (P = .04). One CVA (2.1%) occurred in one group II patient without prior thrombus detection, and none occurred in group I patients (P = ns). Conclusion. Early administration of heparin reduces the risk of early intracardiac thrombus formation during LA ablation procedures. This did not result in reduced rate of CVAs.
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Asbach et al. (2011) conducted a cohort in Atrial Fibrillation (n=55). Early heparin administration (before transseptal access) vs. Heparin administration after transseptal access was evaluated on Early intracardiac thrombus formation (p=0.04). Early heparin administration before transseptal access during left atrial ablation reduced early intracardiac thrombus formation compared to administration after access (0% vs 15.4%; P=0.04).
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