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Effectiveness of a strategy to reduce major vascular complications from catheter ablation of atrial fibrillation

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Abstract

Introduction

Vascular access site complications are among the most frequently observed complications after catheter ablation of atrial fibrillation (AF). We sought to determine whether implementation of a three-point strategy would reduce major vascular complications resulting from catheter ablation of atrial fibrillation.

Methods

Three hundred twenty-four consecutive patients undergoing catheter ablation of AF were studied: 162 in each group (with and without the test strategy). The three-point test strategy included the following: (1) performing the procedure on Warfarin with an INR from 2.0 to 3.5 (mean INR of 2.44), rather than stopping Warfarin prior to the procedure and bridging the patient back to Warfarin with low molecular heparin, (2) using a small 21 G needle to obtain femoral vein access rather than a larger 18 G needle, and (3) eliminating the use of femoral arterial access. Major vascular complications were defined as complications requiring either blood transfusion or surgical/percutaneous repair.

Results

Major vascular complications were identified in 6/162 (3.7%) of the control patients without the strategy listed above compared to 0/162 (0%) in the test patients with implementations of this strategy (p = 0.03). The frequency of other complications was comparable between the two groups (tamponade requiring drainage: 1/162 control, 1/162 test; pericardial effusion not requiring drainage: 0/162 control, 1/162 test; transient ischemic attack: 1/162 control and 1/162 test; stroke: 1/162 control, 0/162 test): (p = NS for each).

Conclusions

A three-point strategy including performing procedures with therapeutic Warfarin, using a small gauge needle to obtain vascular access and eliminating femoral arterial access significantly reduced major vascular access complications and did not affect other major complications, during catheter ablation of AF. Implementation of this strategy may be useful to reduce groin complications resulting from AF ablation.

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Financial Disclosure

FA: none, EKH: Boston Scientific (consultant/honoraria/research grants), St. Jude Medical (consultant/honoraria/research grant), CB: St. Jude Medical (research grants),SD: none, DB: none, CC: none, ZK: none, JNR: Biosense Webster (consultant, fellowship support), Boston Scientific (fellowship support), CardioFocus (clinical oversight committee—no compensation), CardioInsight (scientific advisory board), CryoCath (scientific steering committee—no compensation), Medtronic (consultant, fellowship support), St. Jude Medical (fellowship support), MM: St. Jude Medical (research grants), Biosense-Webster (research grants).

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Authors and Affiliations

  1. Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Gray 109, 55 Fruit St, Boston, MA, 02114, USA

    Fnu Abhishek, Edwin Kevin Heist, Conor Barrett, Stephan Danik, Dan Blendea, Christina Correnti, Zaka Khan, Jeremy N. Ruskin & Moussa Mansour

Authors
  1. Fnu Abhishek
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  2. Edwin Kevin Heist
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  3. Conor Barrett
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  4. Stephan Danik
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  5. Dan Blendea
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  6. Christina Correnti
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  7. Zaka Khan
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  8. Jeremy N. Ruskin
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  9. Moussa Mansour
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Corresponding author

Correspondence to Moussa Mansour.

Additional information

Fnu Abhishek and E. Kevin Heist contributed equally to this manuscript.

This study was supported in part by MGH Deane Institute for Integrative Research in Atrial Fibrillation and Stroke.

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Abhishek, F., Heist, E.K., Barrett, C. et al. Effectiveness of a strategy to reduce major vascular complications from catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 30, 211–215 (2011). https://doi.org/10.1007/s10840-010-9539-8

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  • DOI: https://doi.org/10.1007/s10840-010-9539-8

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