Abstract
Introduction: Single-shot ablation has emerged as an effective
technique for index atrial fibrillation (AF) ablation, with an advantage
of short procedure time. Although recent guidelines recommend
peri-procedural uninterrupted oral anticoagulants (OACs), the
intra-procedural anticoagulation strategy remains uncertain under
non-vitamin K OACs (NOACs). We investigated procedural safety of a
single bolus administration of heparin without activated clotting time
(ACT) measurement during cryoballoon ablation (CBA).
Methods: Two hundred patients (64.2±10.0years, 70% with
non-paroxysmal AF) who underwent CBA with uninterrupted NOACs were
randomly assigned to No-ACT group and ACT group. A bolus of heparin (100
U/kg) was routinely administered immediately after transseptal puncture.
In the ACT group, an additional injection of heparin (30 U/kg) was
administered if ACT at 30-min after the initial bolus was <300
s.
Results: There were no differences in baseline characteristics
including CHA2DS2-VASc score between two
groups. The left atrium indwelling and procedure times were 60.4±13.1
min and 78.9±13.9 min, respectively and not significantly different
between two groups. The mean ACT was 335.2±59.9 s in the ACT group. Any
bleeding rate was 3.2% in all patients and there was no statistically
difference in bleeding complications between two groups. In the ACT
group, groin hematoma, laryngopharyngeal bleeding, and hemoptysis
occurred in 3, 1, and 1 patient, respectively. Cardiac tamponade
occurred in 1 patient in the No-ACT group. No thromboembolic events
occurred during the 30-day follow-up after CBA.
Conclusion: Single bolus administration of heparin without ACT
measurement is a feasible anticoagulation strategy for CBA in patients
with uninterrupted NOACs intake.