When Should Heparin Preferably Be Administered During Radiofrequency Catheter Ablation?

Abstract

RF catheter ablation is complicated by thromboembolism in about 1% of patients. Limited knowledge exists concerning when and how to use anticoagulation or antithrombotic treatment. We studied the activation of coagulation (prothrombin fragment 1 + 2 [PF1 + 2] and D-dimer), platelets (beta-thromboglobulin [beta-TG]) and fibrinolysis (plasmin-antiplasmin complexes [PAP]) during RF ablation of accessory pathways in 30 patients. They were randomized to receive heparin (100 IU/kg, intravenously) (1) immediately after introduction of the femoral venous sheaths (group I) or (2) after the initial electrophysiological study, prior to the delivery of RF current (groups II and III). Group II additionally received saline irrigation of all femoral sheaths. After the initial bolus, 1,000 IU of heparin was supplied hourly in all groups. Within groups II and III, median plasma values of PF1 + 2 and beta-TG more than tripled (P < or = 0.007) during the diagnostic study and gradually declined during heparin administration despite RF current delivery. Median D-dimer tripled (P = 0.005) and PAP doubled (NS) before heparin administration; then both remained around the upper reference values. In the early heparin group, however, PF1 + 2, D-dimer, and PAP did not rise at all, and beta-TG showed only a slight increase towards the end of the procedure. The differences between group I versus groups II and III were statistically significant prior to the first RF current delivery (PF1 + 2, D-dimer, and beta-TG) and by the end of the procedure (PF1 + 2, D-dimer, and PAP). In conclusion, "late" heparin administration allows hemostatic activation during the initial catheterization and diagnostic study. By administering intravenous heparin immediately after introduction of the venous sheaths, hemostatic activation is significantly decreased. Saline irrigation of the venous sheaths added nothing to late heparin administration.

Delayed Thrombogenesis Following Radiofrequency Catheter Ablation.

“…The hemostasis that occurs with the placement of catheters has been described, 6,7,16,17 with some investigators correlating it with the duration of the pre-heparin procedure, as was seen in the present study. 7 Another report showed that platelet aggregability increased during RF current delivery, 9 and Manolis et al showed that RF-CA provoked an elevation in the D-dimer concentration by 48 h after the procedure.…”

“…According to our results, the elevation of the D-dimer concentration reported by Manolis et al might represent the delayed phase, but comparison of the present and previous studies depends on the anticoagulation regimen, including the administration of heparin and low molecular weight heparin. 7,8,17 …”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…The benefit of heparinization administration during catheter ablation procedures is unclear, with several reports demonstrating either no benefit or no enhanced benefit with earlier heparin administration after placement of sheaths. 544,556,557 Epstein et al 558 demonstrated a low incidence of embolic complications among 758 pediatric and congenital patients from 11 centers. A wide variety of anticoagulation protocols was used, but all used heparin for left-side ablations.…”

Left Atrial Catheter Ablation and Ischemic Stroke

“…Third, LACA induces an immediate systemic activation of platelets and of the coagulation system. 31,32 Fourth, despite a high spontaneous closure rate, the trans-septal puncture may leave a persisting atrial septal defect even after 6 months, 33 opening the door for paradoxical embolism. Fifth, periprocedural cardioversion may increase the risk of thrombus formation, 23,34 but available data are inconsistent.…”