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Mujovic N, Potpara TS. Pulmonary Thromboembolism after Catheter Ablation of Cardiac Arrhythmias. Thromb Haemost 2024; 124:870-873. [PMID: 39013457 DOI: 10.1055/a-2366-7245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Affiliation(s)
- Nebojsa Mujovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Invasive Electrophysiology, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Intensive Arrhythmia Care, Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
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2
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Mugnai G, Farkowski M, Tomasi L, Roten L, Migliore F, de Asmundis C, Conte G, Boveda S, Chun JKR. Prevention of venous thromboembolism in right heart-sided electrophysiological procedures: results of an European Heart Rhythm Association survey. Europace 2023; 26:euad364. [PMID: 38091971 PMCID: PMC10754160 DOI: 10.1093/europace/euad364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023] Open
Abstract
Limited data are available regarding venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), following right-sided ablations and electrophysiological (EP) studies. Compared to left-sided procedures, no guidelines on antithrombotic management strategies for the prevention of DVT and PE are available. The main purpose of the present European Heart Rhythm Association (EHRA) survey is to report the current management of right-sided EP procedures, focusing on anticoagulation and prevention of VTE. An online survey was conducted using the EHRA infrastructure. A total of 244 participants answered a 19-items questionnaire on the periprocedural management of EP studies and right-sided catheter ablations. The right femoral vein is the most common access for EP studies and right-sided procedures. An ultrasound-guided approach is employed by more than 2/3 of respondents. Intravenous heparin is not commonly given by the majority of participants. About 1/3 of participants (34%) routinely prescribe VTE prophylaxis during (mostly aspirin and low molecular weight heparin) and 1/4 of respondents (25%) commonly prescribe VTE prophylaxis after discharge (mostly aspirin). Of note, respectively 13% and 9% of participants observed at least one DVT and one PE related to right-sided ablation or EP study within the last year in their center. The present survey shows that only a minority of operators routinely gives intraprocedural intravenous heparin and prescribes VTE prophylaxis after right-sided EP procedures. Compared to left-sided procedures like atrial fibrillation (AF) ablation, there are no consistent systematic antithrombotic management strategies.
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Affiliation(s)
- Giacomo Mugnai
- Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Michal Farkowski
- Department of Cardiology, Ministry of Interior and Administration National Medical Institute, Warsaw, Poland
| | - Luca Tomasi
- Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt Am Main, Germany
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Bruce C, Saraf K, Rogers S, El-Omar M, Kirkwood G, Kelland NF, Shah D, Chalil S, Fullwood C, Wright M, Jamil-Copley S, Fox D, Abozguia K, Thachil J, McCollum C, Morris GM. Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk. Heart Lung Circ 2022; 31:1015-1022. [PMID: 35301985 DOI: 10.1016/j.hlc.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac catheter ablations are an established treatment for supraventricular tachycardia (SVT) involving prolonged cannulation of the common femoral vein with multiple catheters. This study aimed to identify the risk of deep vein thrombosis (DVT) by studying the frequency of this complication after catheter ablation. METHODS This was a prospective multi-centre cohort study of patients undergoing cardiac ablation for atrioventricular nodal re-entry tachycardia or right-sided accessory atrioventricular connection. Those taking anticoagulation or antiplatelet therapy prior to the procedure were excluded. Following the procedure, bilateral venous duplex ultrasonography from the popliteal vein to the inferior vena cava for DVT was undertaken at 24 hours and between 10 to 14 days. RESULTS Eighty (80) patients (mean age 47.6 yrs [SD 13.4] with 67% female) underwent cardiac ablation (median duration 70 mins). Seven (7) patients developed acute DVT in either the femoral or external iliac vein of the intervention leg, giving a frequency of 8.8% (95% CI 3.6-17.2%). No thrombus was seen in the contralateral leg (p=0.023). An elevated D-dimer prior to the procedure was significantly more frequent in patients developing DVT (42.9% vs 4.1%, p=0.0081; OR 17.0). No other patient or procedural characteristics significantly influenced the risk of DVT. CONCLUSION In patients without peri-procedural anticoagulation catheter ablation precipitated DVT in the catheterised femoral or iliac veins in 8.8% of patients. Peri-procedure prophylactic anticoagulation may be considered for all patients undergoing catheter ablation for SVT. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03877770.
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Affiliation(s)
- Charo Bruce
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Karan Saraf
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences within the School of Medicine, University of Manchester, Manchester, UK
| | - Steven Rogers
- Independent Vascular Services Ltd, Manchester University NHS Foundation Trust, Manchester, UK
| | - Magdi El-Omar
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graeme Kirkwood
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Nicholas F Kelland
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Dinakshi Shah
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Shajil Chalil
- Clinical Cardiac Electrophysiologist at Marshall University Joan C. Edwards School of Medicine Huntington, WV, USA
| | - Catherine Fullwood
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matthew Wright
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shahnaz Jamil-Copley
- Department of Cardiology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - David Fox
- North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Khalid Abozguia
- Clinical Cardiac Electrophysiologist at Marshall University Joan C. Edwards School of Medicine Huntington, WV, USA
| | - Jecko Thachil
- Department of Haematology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Charles McCollum
- North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK; Academic Surgery Unit, University of Manchester, Manchester, UK
| | - Gwilym M Morris
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences within the School of Medicine, University of Manchester, Manchester, UK.
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Ngo L, Ali A, Ganesan A, Woodman R, Adams R, Ranasinghe I. Ten-year trends in mortality and complications following catheter ablation of atrial fibrillation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:398-408. [PMID: 34982824 DOI: 10.1093/ehjqcco/qcab102] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
AIMS Recent US studies report rising rates of mortality and in-hospital complications following catheter ablation of atrial fibrillation (AF), but whether this is a global phenomenon is uncertain. The aim of this study was to examine trends in 30-day mortality and complications following AF ablation in Australia and New Zealand (ANZ) from 2008 to 2017. METHODS AND RESULTS We identified 37 243 AF (mean age 62.4 ± 11.5 years, 29.6% females, 94.5% elective procedures) ablations using national hospitalization data. The primary outcome was occurrence of any complication, including all-cause mortality, within 30 days of discharge. Trends were evaluated using logistic regression adjusting for changes in patient characteristics. The annual number of ablations increased from 1359 (2008) to 5115 (2017). Patients' age and rates of heart failure (9.8-10.6%), diabetes (6.8-12.4%), and chronic kidney disease (2.2-4.1%) also increased over time. From 2008 to 2017, the overall rate of complications declined from 7.51% to 5.04% [adjusted odds ratio (aOR) 0.96 (95% confidence interval, CI, 0.94-0.97)/year]. Rates of pericardial effusion [1.69-0.70%, aOR 0.93 (0.89-0.97)], bleeding [4.49-2.74%, aOR 0.94 (0.92-0.96)], and vascular injury [0.52-0.16%, aOR 0.91 (0.85-0.98)] declined, but rates of acute kidney injury [0.15-0.68%, aOR 1.16 (1.08-1.25)] and infection [0.15-0.57%, aOR 1.07 (1.01-1.14)] increased over time. The overall 30-day mortality rate was low (0.11%) and unchanged [0.00-0.16%, aOR 0.99 (0.88-1.11)]. CONCLUSION Despite a five-fold increase in AF ablations and the rising risk profile of patients, complications following AF ablation declined by 30% from 2008 to 2017 in ANZ. Procedure-related death was uncommon and occurred in less than 1 in 850 patients.
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Affiliation(s)
- Linh Ngo
- School of Clinical Medicine, Faculty of Medicine, the University of Queensland, QLD, Brisbane, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD 4032, Brisbane, Australia
- Department of Cardiovascular and Thoracic Surgery, Cardiovascular Centre, E Hospital, Hanoi, Vietnam
| | - Anna Ali
- School of Medicine, Faculty of Health and Medical Sciences, the University of Adelaide, SA, Adelaide, Australia
| | - Anand Ganesan
- Department of Cardiovascular Medicine, Flinders Medical Centre, SA, Australia
- College of Medicine and Public Health, Flinders University, SA, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine and Public Health, Flinders University, SA, Australia
| | - Robert Adams
- College of Medicine and Public Health, Flinders University, SA, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA, Adelaide, Australia
| | - Isuru Ranasinghe
- School of Clinical Medicine, Faculty of Medicine, the University of Queensland, QLD, Brisbane, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD 4032, Brisbane, Australia
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Pothineni NVK, Tschabrunn CM, Carrillo R, Schaller RD. Endovascular occlusion balloon-related thrombosis during transvenous lead extraction. Europace 2021; 23:1472-1478. [PMID: 33822905 DOI: 10.1093/europace/euab074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/23/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study is to evaluate the incidence, predictors, and outcomes of balloon-related thrombosis (BRT) in patients undergoing transvenous lead extraction (TLE). Use of an endovascular occlusion balloon has improved outcomes of superior vena cava injuries during TLE. Its thrombogenicity in clinical practice is unknown. METHODS AND RESULTS We prospectively evaluated consecutive patients undergoing prophylactic balloon placement during TLE utilizing two procedural workflows: one with the balloon within the inferior vena cava during the entire case (standard cohort) and one limiting the balloon's dwell time (abbreviated cohort). Intracardiac echocardiography was used to evaluate for significant BRT (thrombus > 1 cm) after TLE. Forty-two patients (21 in each group) were included. Age, left ventricular ejection fraction, procedural indication, number of leads, and lead dwell time were similar between the groups. Balloon dwell time was significantly longer in the standard group (128 ± 74 vs. 25 ± 18 min, P < 0.001) as was BRT (14/21 vs. 1/21, P < 0.001). Mean thrombus length and width in the standard group was 3.99 ± 1.40 and 0.45 ± 0.16 cm, respectively and 5.2 × 0.4 cm in one patient in the abbreviated group. Between patients with and without BRT in the standard group, balloon dwell times were similar (113 ± 64 vs. 156 ± 88 min, P = 0.21). One patient in the standard group had a pulmonary embolism on post-operative Day 3 and was initiated on oral anticoagulation. CONCLUSION Prophylactic balloon placement for the entirety of the case is associated with a high incidence of BRT; a finding that is decreased when an abbreviated workflow is utilized.
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Affiliation(s)
- Naga Venkata K Pothineni
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Cory M Tschabrunn
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Saunderson C, Hickman S, Wilkinson E, Tayebjee M. Current Venous Thromboembolism Prevention Practices Following Endovascular Electrophysiological Procedures in the UK: A retrospective study. Sultan Qaboos Univ Med J 2018; 18:e374-e378. [PMID: 30607281 DOI: 10.18295/squmj.2018.18.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/30/2018] [Accepted: 04/22/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to evaluate the incidence of venous thromboembolism (VTE) cases at the Leeds General Infirmary, Leeds, UK, as well as to survey current VTE practices and preventative strategies at other UK-based electrophysiology (EP) centres. Methods This retrospective study involved all patients who underwent EP studies at Leeds General Infirmary from January 2014 to December 2016. In addition, a telephone survey was conducted of 35 other UK-based EP centres. Results Of 1,020 patients who underwent EP studies at Leeds General Infirmary, 0.3% developed a post-procedural VTE. In addition, 28 other EP centres were surveyed (response rate: 80%), of which 18% reported VTE cases in the last two years. There were wide variations in VTE prevention strategies and the use of post-procedural thromboprophylaxis. Conclusion Despite the low incidence of VTE cases, many UK centres continue to experience this complication with no consensus on optimal preventative strategies. As current VTE guidelines do not recommend antithrombotics after EP studies, further research is needed.
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Affiliation(s)
| | - Sally Hickman
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Elaine Wilkinson
- School of Allied Health Professions & Sport, University of Bradford, Bradford, UK
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