INTRODUCTION
Arrhythmia treatment via left atrial ablation procedures is associated
with peri-procedural risk of thromboembolism at a reported rate of
0-7%.1 To mitigate this risk, meticulous
peri-procedural practices should be employed including pre-procedural
imaging to rule out left atrial thrombus, vigilant sheath management,
careful control of radiofrequency (RF) energy, and a strict
peri-procedural anticoagulation strategy. Prior studies have
demonstrated that thrombi can form on sheaths or catheters almost
immediately after transseptal puncture, and peri-procedural
anticoagulation via intravenous heparin can reduce this
risk.2,3A therapeutic Activated Clotting Time (ACT)
goal of > 300 seconds should be targeted, as this
value has been associated with reduced thromboembolic complications,
without increased bleeding complications.4,5
Contemporary anticoagulation practices during left atrial catheter
ablation procedures can vary among operators, particularly in regard to
the effect of patient size and peri-procedural oral anticoagulation. To
reduce the likelihood of sub-therapeutic heparin dosing, a weight-based
heparin dosing policy which adjusted for pre-procedural oral
anticoagulation was implemented. We performed an observational quality
improvement study to evaluate whether an implemented protocol would
result in altered dosing practices, a greater prevalence of therapeutic
ACT values, and a decrease in time to therapeutic ACT during left atrial
ablation procedures compared to a retrospective cohort of similar
patients.