Key result
Procedure duration prior to heparin administration, rather than radiofrequency current delivery, determined the activation of coagulation, with a strong correlation to PF1+2 rise (r=0.83, P<0.001).
Why the study?
Does procedure duration prior to heparin administration determine activation of hemostasis and fibrinolysis during RF ablation?
Observational (n=13)
Does procedure duration prior to heparin administration determine activation of hemostasis and fibrinolysis during RF ablation?
The activation of hemostasis and fibrinolysis during RF ablation is determined by the duration of the procedure prior to heparin administration, not by the delivery of RF current itself.
Answers are grounded in this paper and cite their sources.
Earlier heparin may limit coagulation activation during ablation; hypothesis-generating and requires randomized confirmation before practice change.
INTRODUCTION: Catheter ablation may be complicated by clinical thromboembolism in about 1% of patients. METHODS AND RESULTS: We studied the activation of coagulation (prothrombin fragment 1+2 [PF1+2]), platelets (beta-thromboglobulin [beta-TG])) and fibrinolysis (plasmin-antiplasmin complexes [PAP] and D-dimer) during radiofrequency (RF) ablation in 13 patients. They received heparin 100 U/kg intravenously after the initial electrophysiologic study, prior to the delivery of RF current; thereafter 1,000 U/hour throughout the procedure. PF1+2 increased fourfold (P < 0.001) during the diagnostic study, but gradually declined to upper reference value during heparin administration. There was a strong correlation between procedure duration prior to heparin bolus (range 39 to 173 min); and (a) the maximal rise of PF1+2 (r = 0.83, P < 0.001) and (b) the increase of PF1+2 from baseline to end of the procedure (r = 0.74, P = 0.004). There was no correlation between postheparin changes of PF1+2 and (a) postheparin procedure duration (range 40 to 317 min), (b) number of RF pulses (range 1 to 16), or (c) RF current duration (range 46 to 687 sec). Plasma beta-TG concentration showed similar trends. Fibrinolytic activity increased moderately from baseline until heparin administration; then remained around the upper reference values. PAP at the end of procedure and D-dimer at the time of heparin administration both correlated with preheparin procedure duration (r = 0.70, P = 0.007 and r = 0.69, P = 0.01, respectively). All parameters were normal the next morning. CONCLUSION: Procedure duration prior to heparin administration, and not the delivery of RF current per se, determines activation of hemostasis and fibrinolysis during RF ablation.
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Anfinsen et al. (1999) conducted an observational in Patients undergoing radiofrequency catheter ablation (n=13). Procedure duration prior to heparin administration was evaluated on Maximal rise of prothrombin fragment 1+2 (PF1+2) (r = 0.83, p=<0.001). Procedure duration prior to heparin administration, rather than radiofrequency current delivery, determined the activation of coagulation, with a strong correlation to PF1+2 rise (r=0.83, P<0.001).
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