Author + information
- Konstantinos Siontis,
- Rakesh Latchamsetty,
- Miki Yokokawa,
- Krit Jongnarangsin,
- Fred Morady and
- Frank Bogun
Background: Ablation in the left ventricle (LV) carries a risk of thrombus formation. The use of anticoagulation needs to be balanced against the risk of access and non-access site bleeding.
Methods: We assessed the utility of a standardized post-procedural anticoagulation protocol (Figure) in 130 patients (93.1% male, median age 69 years) undergoing LV catheter ablation for infarct-related VT. Acute and follow-up bleeding and thromboembolic events were documented.
Results: Post-ablation bridging with a low-intensity unfractionated heparin (UFH) regimen was used in 108 (83.1%) patients, while bridging anticoagulation was not used in 22 (16.9%) patients without extensive ablation. Post-discharge anticoagulation for at least 3 months was used in 114 of 127 patients discharged alive. In the remaining 13 patients, only antiplatelet agents were used. One (0.8%) patient experienced a potentially embolic lower extremity arterial occlusion a few hours post-ablation, but no post-discharge embolic events occurred in the first 6 months. Among patients receiving bridging anticoagulation, 17 (15.7%) had minor and 1 (0.9%) had major access bleeding requiring surgical intervention within 24 hours post-ablation, while 2 (1.8%) patients had hematuria (days 1 and 3 post-ablation).
Conclusions: A slowly escalating bridging regimen of UFH, followed by 3 months of warfarin appears safe after LV ablation. In the absence of extensive ablation, antiplatelet therapy only may also be a reasonable approach.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Specific Situations and Newer Outcome Measures
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1190-104
- 2017 American College of Cardiology Foundation