Thrombogenicity of radiofrequency ablation procedures: what factors influence thrombin generation?

Abstract

Radiofrequency ablation procedures confer an increased risk of thrombosis. Catheterization and diagnostic study contribute largely to the thrombogenic stimulus. Thrombogenicity is increased in prolonged, complex procedures and is decreased in patients who have been administered heparin during the procedure.

Microembolism and Catheter Ablation I

“…7,8 The other mechanisms could include atrial stunning with stasis of blood and thrombus formation, similar to that observed after electric cardioversion, 9 or endocardial disruption creating a thrombogenic state. 10 Recent reports have described a high prevalence of asymptomatic cerebral lesions after AF ablation procedures observed on diffusion-weighted MRI (DWI) that are presumed to be embolic in origin. [11][12][13][14][15][16] However, the exact mechanism and composition of the embolic material have not been characterized.…”

Radiofrequency Catheter Ablation of Atrial Fibrillation: A Cause of Silent Thromboembolism?

“…Periprocedural cerebrovascular accidents may be caused by preexisting LA thrombus not seen on transesophageal echocardiography, char formation on radiofrequency ablation catheters or ablated tissue, thrombus formation on LA catheters and sheaths, air embolus, or periprocedural development of new atrial thrombus after conversion of AF to sinus rhythm. 19,20 All of the measures commonly used to minimize the risk of periprocedural stroke were taken routinely during the procedure: a preprocedural transesophageal echocardiogram, anticoagulation before the procedure, intraprocedural use of heparin, continuous flushing of the sheaths, and use of irrigated-tip catheters. …”

“…The aforementioned mechanisms can cause activation of the cascade of events that ultimately results in thrombin generation and platelet activation. 19,20 The mechanical trauma due to electric cardioversion or the restored atrial contractility after AF may dislocate LA microthrombi, causing cerebral embolism. On the other hand, we cannot exclude that a group of patients at high risk of thromboembolism because of underlying substrate resistant to ablation have been selected, and further ablation may increase the risk of thromboembolism.…”

Pulmonary Thromboembolism Caused by Prolonged Compression at the Femoral Access Site and a Venous Aneurysm of the Ipsilateral Popliteal Vein

“…6) In addition, greater sheath diameter used for venous catheterization, which is reported an independent predictor of thrombus occurrence with odds ratio of 1.41 per 1-French, might play an important role in catheter-related DVT. 2,7) Venous sheath placement itself might promote thrombogenesis by injuring the vessel wall, reducing the lumen and activating the coagulation cascade, 8) which of action is the increase of shear stress in microcirculation of the vein wall releasing anti-inflammatory and anti-coagulatory mediators. 10) Although compression therapies are costly, cumbersome to use, and can cause skin injury, they should be recommended as prophylaxis especially in patients with high risk of VTE.…”