Randomized Comparison of a Continuous and Intermittent Heparin Infusion During Catheter Ablation of Atrial Fibrillation
mag(2016)
摘要
Fro Da Me De of Pa Th ha Ma OBJECTIVES This study tested the hypothesis that continuous heparin infusions would be favorable for maintaining heparin concentrations during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). BACKGROUND Heparin infusions are essential for RFCA of AF. There is a paucity of data on the details for the optimal heparin infusion during RFCA of AF. METHODS A total of 333 patients undergoing AF ablation were consecutively enrolled and randomized to intermittent or continuous heparin infusion. A heparin bolus of 100 U/kg was injected just prior to transseptal puncture. The heparin concentration necessary to maintain an optimal activated clotting time (ACT) (300 to 400 s) was determined and checked every 30 min during the procedure. The primary endpoint of the study was the frequency of the maintenance of an optimal intraprocedural ACT. RESULTS The frequency of an optimal ACT in the continuous group was significantly higher than that in the intermittent group (64.0% vs. 57.6%, respectively, p < 0.01), whereas the total heparin level was significantly lower in the continuous group (13,162 4,634 U vs. 15,837 5,243 U, respectively, p < 0.01). The standard deviation of the ACT was significantly smaller in the continuous group than in the intermittent group (49 30 vs. 33 18, respectively, p < 0.01). Ninety-six patients had new oral anticoagulants (NOACs) before the procedure, and an optimal ACT at the first ACT check was less frequent than in patients taking warfarin (12.5% vs. 59.1%, respectively, p < 0.01). There were no significant differences in periprocedural bleeding or thromboembolic complications between the groups. CONCLUSIONS During AF ablation, a continuous heparin infusion was superior to an intermittent heparin infusion for maintaining an optimal ACT range. (Randomized Comparison of Continuous and Intermittent Heparin Infusion During Catheter Ablation of Atrial Fibrillation [COHERE]; NCT01935557) (J Am Coll Cardiol EP 2016;2:319–26) © 2016 by the American College of Cardiology Foundation. R adiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is an effective therapeutic option for the treatment of symptomatic, drug-refractory AF. RFCA of AF is technically m the Division of Cardiology, Department of Internal Medicine, Colle ejeon St. Mary’s Hospital, Daejon, Republic of Korea; Division of Cardi dicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, S partment of Internal Medicine, College of Medicine, The Catholic Univers Korea; Division of Cardiology, Department of Internal Medicine, Colleg ul’s Hospital, Seoul, Republic of Korea; and the Division of Cardiology, De e Catholic University of Korea, Yeouido St. Mary’s Hospital, Yeouido, Rep ve no relationships relevant to the contents of this paper to disclose. nuscript received August 13, 2015; revised manuscript received October 2 challenging and associated with the risk of periprocedural complications, including thromboembolism. The incidence of periprocedural thromboembolic events is reported to be as high as 0.5% to 4.0%, ge of Medicine, The Catholic University of Korea, ology, Department of Internal Medicine, College of eoul, Republic of Korea; Division of Cardiology, ity of Korea, St. Vincent’s Hospital, Suwon, Republic e of Medicine, The Catholic University of Korea, St. partment of Internal Medicine, College of Medicine, ublic of Korea. The authors have reported that they 6, 2015, accepted November 19, 2015. ABBR EV I A T I ON S
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