Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation

Abstract

Early administration of intravenous heparin, specifically before transseptal puncture, decreases the incidence of left atrial thrombi.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…It has been observed that thrombi can form on the transseptal sheath and/or the electrode catheter almost immediately after crossing the septum and that early heparinization substantially decreases this risk. 768,802,803,804,846,847,848 A recent meta-analysis of more than 7000 patients supports this recommendation, showing that performing ablation of AF with a target ACT >300 seconds decreases the risk of thromboembolic complications without increasing the risk of bleeding. 849 Seventy-seven percent of the writing group members administer heparin prior to the transseptal puncture.…”

Left Atrial Catheter Ablation and Ischemic Stroke

“…23 These data indicate that an activated clotting time of 300 to 400 seconds may be optimal for minimizing thrombembolic events, whereas there was no benefit from heparin and a glycoprotein IIb/IIIa inhibitor application compared to heparin alone. 44 The time point of heparin application also seems to be important because hemostatic activation 31 and thrombus formation 45 were significantly…”

Contemporary Management of Atrial Fibrillation: Update on Anticoagulation and Invasive Management Strategies

“…143,165 Early heparinization, the use of intracardiac ultrasonography, and aggressive anticoagulation regimens appear to have reduced the incidence of this complication. 180 Left Atrial-Esophageal Fistula. A potentially catastrophic consequence of AF ablation is the formation of a fistula between the posterior left atrium and the esophagus.…”