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Safety of Lower Activated Clotting Times During Atrial Fibrillation Ablation Using Open Irrigated Tip Catheters and a Single Transseptal Puncture
Guidelines largely based on closed-tip catheters recommend activated clotting times (ACTs) >300 to 350 seconds during atrial fibrillation (AF) ablation to prevent thrombus and char formation. Open irrigated tip catheters (OITC) may decrease complications and permit lower ACTs. This study evaluate...
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| Published in: | The American journal of cardiology 2011-03, Vol.107 (5), p.704-708 |
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| cites | cdi_FETCH-LOGICAL-c542t-2b73ab035c6a77675d7a363c39351cd42c008b91b9f909cbb1bf3206bd710e673 |
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| container_title | The American journal of cardiology |
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| creator | Winkle, Roger A., MD Mead, R. Hardwin, MD Engel, Gregory, MD Patrawala, Rob A., MD |
| description | Guidelines largely based on closed-tip catheters recommend activated clotting times (ACTs) >300 to 350 seconds during atrial fibrillation (AF) ablation to prevent thrombus and char formation. Open irrigated tip catheters (OITC) may decrease complications and permit lower ACTs. This study evaluated factors contributing to vascular and hemorrhagic complications during AF ablation with emphasis on catheter type, anticoagulation level, procedural and clinical variables, and gender. In 1,122 AF ablations we examined catheter used, ACT level, gender, and complications. Target ACTs initially were >300 seconds and were decreased to 225 seconds for the OITC. Average ACT ranges were created: 350 seconds. Average ACT was 350 seconds (p = 0.038). Women were older (66 ± 10 vs 60 ± 10 years, p |
| doi_str_mv | 10.1016/j.amjcard.2010.10.048 |
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Hardwin, MD ; Engel, Gregory, MD ; Patrawala, Rob A., MD</creator><creatorcontrib>Winkle, Roger A., MD ; Mead, R. Hardwin, MD ; Engel, Gregory, MD ; Patrawala, Rob A., MD</creatorcontrib><description>Guidelines largely based on closed-tip catheters recommend activated clotting times (ACTs) >300 to 350 seconds during atrial fibrillation (AF) ablation to prevent thrombus and char formation. Open irrigated tip catheters (OITC) may decrease complications and permit lower ACTs. This study evaluated factors contributing to vascular and hemorrhagic complications during AF ablation with emphasis on catheter type, anticoagulation level, procedural and clinical variables, and gender. In 1,122 AF ablations we examined catheter used, ACT level, gender, and complications. Target ACTs initially were >300 seconds and were decreased to 225 seconds for the OITC. Average ACT ranges were created: <250, 250 to 299, 300 to 350, and >350 seconds. Average ACT was <250 seconds in 557 ablations (complication rate 1.62%). Cochran–Armitage analysis showed that complications increased linearly as ACT increased and peaked at 5.55% for ablations with ACTs >350 seconds (p = 0.038). Women were older (66 ± 10 vs 60 ± 10 years, p <0.001) and had more paroxysmal AF (43% vs 28%, p = 0.007) and more hypertension (50% vs 40%, p = 0.013). Women received less heparin but were over-represented in higher ACT ranges (p <0.0001) consistent with a pharmacokinetic gender difference. There was no difference in vascular or hemorrhagic complications between men and women (2.3% vs 2.9%, p = 0.668). Multivariate logistic regression showed that only use of the OITC was associated with lower complication rates (p = 0.024). In conclusion, AF ablation with the OITC is safe with a target ACT of 225 seconds.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2010.10.048</identifier><identifier>PMID: 21185007</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Atrial Fibrillation - blood ; Atrial Fibrillation - diagnostic imaging ; Atrial Fibrillation - surgery ; Atrial Septum - surgery ; Biological and medical sciences ; Blood Coagulation - physiology ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology ; Cardiology. 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Hardwin, MD</creatorcontrib><creatorcontrib>Engel, Gregory, MD</creatorcontrib><creatorcontrib>Patrawala, Rob A., MD</creatorcontrib><title>Safety of Lower Activated Clotting Times During Atrial Fibrillation Ablation Using Open Irrigated Tip Catheters and a Single Transseptal Puncture</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Guidelines largely based on closed-tip catheters recommend activated clotting times (ACTs) >300 to 350 seconds during atrial fibrillation (AF) ablation to prevent thrombus and char formation. Open irrigated tip catheters (OITC) may decrease complications and permit lower ACTs. This study evaluated factors contributing to vascular and hemorrhagic complications during AF ablation with emphasis on catheter type, anticoagulation level, procedural and clinical variables, and gender. In 1,122 AF ablations we examined catheter used, ACT level, gender, and complications. Target ACTs initially were >300 seconds and were decreased to 225 seconds for the OITC. Average ACT ranges were created: <250, 250 to 299, 300 to 350, and >350 seconds. Average ACT was <250 seconds in 557 ablations (complication rate 1.62%). Cochran–Armitage analysis showed that complications increased linearly as ACT increased and peaked at 5.55% for ablations with ACTs >350 seconds (p = 0.038). Women were older (66 ± 10 vs 60 ± 10 years, p <0.001) and had more paroxysmal AF (43% vs 28%, p = 0.007) and more hypertension (50% vs 40%, p = 0.013). Women received less heparin but were over-represented in higher ACT ranges (p <0.0001) consistent with a pharmacokinetic gender difference. There was no difference in vascular or hemorrhagic complications between men and women (2.3% vs 2.9%, p = 0.668). Multivariate logistic regression showed that only use of the OITC was associated with lower complication rates (p = 0.024). 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Vascular system</subject><subject>Cardiovascular</subject><subject>Catheter Ablation - instrumentation</subject><subject>Catheters</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gender differences</subject><subject>Heart</subject><subject>Heart Diseases - prevention & control</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Postoperative Complications - prevention & control</subject><subject>Punctures - instrumentation</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Studies</subject><subject>Thrombosis - blood</subject><subject>Thrombosis - prevention & control</subject><subject>Treatment Outcome</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNqFkttu1DAQhiMEokvhEUAWEuIqiw9JHN-AVguFSisVabfXlu1MikNOtZ2ifQzeGKcbitQbrsZjffPbM_8kyWuC1wST4kOzVl1jlKvWFN_frXFWPklWpOQiJYKwp8kKY0xTQTJxlrzwvokpIXnxPDmjhJQ5xnyV_N6rGsIRDTXaDb_AoY0J9k4FqNC2HUKw_Q062A48-jy5OdkEZ1WLLqx2tm1VsEOPNno5XPsZuRqhR5fO2Zt7nYMd0VaFHxDAeaT6Cim0j1wL6OBU7z2MISp-n3oTJgcvk2e1aj28WuJ5cn3x5bD9lu6uvl5uN7vU5BkNKdWcKY1ZbgrFecHziitWMMMEy4mpMmowLrUgWtQCC6M10TWjuNAVJxgKzs6T9yfd0Q23E_ggO-sNxJ56GCYvy5zwrCQCR_LtI7IZJtfHz0WIs4wKWkYoP0HGDd47qOXobKfcURIsZ8dkIxfH5OzYfB0di3VvFvFJd1A9VP21KALvFkB5o9o6jsxY_49josBZRiP36cRBHNqdBSe9sdAbqKwDE2Q12P9-5eMjBdPa3sZHf8IR_EPTRHoqsdzP6zVvF4mRZixnfwCi68u9</recordid><startdate>20110301</startdate><enddate>20110301</enddate><creator>Winkle, Roger A., MD</creator><creator>Mead, R. Hardwin, MD</creator><creator>Engel, Gregory, MD</creator><creator>Patrawala, Rob A., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20110301</creationdate><title>Safety of Lower Activated Clotting Times During Atrial Fibrillation Ablation Using Open Irrigated Tip Catheters and a Single Transseptal Puncture</title><author>Winkle, Roger A., MD ; Mead, R. Hardwin, MD ; Engel, Gregory, MD ; Patrawala, Rob A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c542t-2b73ab035c6a77675d7a363c39351cd42c008b91b9f909cbb1bf3206bd710e673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - blood</topic><topic>Atrial Fibrillation - diagnostic imaging</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrial Septum - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood Coagulation - physiology</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Catheter Ablation - instrumentation</topic><topic>Catheters</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gender differences</topic><topic>Heart</topic><topic>Heart Diseases - prevention & control</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Postoperative Complications - prevention & control</topic><topic>Punctures - instrumentation</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Studies</topic><topic>Thrombosis - blood</topic><topic>Thrombosis - prevention & control</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Winkle, Roger A., MD</creatorcontrib><creatorcontrib>Mead, R. Hardwin, MD</creatorcontrib><creatorcontrib>Engel, Gregory, MD</creatorcontrib><creatorcontrib>Patrawala, Rob A., MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Winkle, Roger A., MD</au><au>Mead, R. Hardwin, MD</au><au>Engel, Gregory, MD</au><au>Patrawala, Rob A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety of Lower Activated Clotting Times During Atrial Fibrillation Ablation Using Open Irrigated Tip Catheters and a Single Transseptal Puncture</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2011-03-01</date><risdate>2011</risdate><volume>107</volume><issue>5</issue><spage>704</spage><epage>708</epage><pages>704-708</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Guidelines largely based on closed-tip catheters recommend activated clotting times (ACTs) >300 to 350 seconds during atrial fibrillation (AF) ablation to prevent thrombus and char formation. Open irrigated tip catheters (OITC) may decrease complications and permit lower ACTs. This study evaluated factors contributing to vascular and hemorrhagic complications during AF ablation with emphasis on catheter type, anticoagulation level, procedural and clinical variables, and gender. In 1,122 AF ablations we examined catheter used, ACT level, gender, and complications. Target ACTs initially were >300 seconds and were decreased to 225 seconds for the OITC. Average ACT ranges were created: <250, 250 to 299, 300 to 350, and >350 seconds. Average ACT was <250 seconds in 557 ablations (complication rate 1.62%). Cochran–Armitage analysis showed that complications increased linearly as ACT increased and peaked at 5.55% for ablations with ACTs >350 seconds (p = 0.038). Women were older (66 ± 10 vs 60 ± 10 years, p <0.001) and had more paroxysmal AF (43% vs 28%, p = 0.007) and more hypertension (50% vs 40%, p = 0.013). Women received less heparin but were over-represented in higher ACT ranges (p <0.0001) consistent with a pharmacokinetic gender difference. There was no difference in vascular or hemorrhagic complications between men and women (2.3% vs 2.9%, p = 0.668). Multivariate logistic regression showed that only use of the OITC was associated with lower complication rates (p = 0.024). In conclusion, AF ablation with the OITC is safe with a target ACT of 225 seconds.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>21185007</pmid><doi>10.1016/j.amjcard.2010.10.048</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Atrial Fibrillation - blood Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - surgery Atrial Septum - surgery Biological and medical sciences Blood Coagulation - physiology Cardiac arrhythmia Cardiac dysrhythmias Cardiology Cardiology. Vascular system Cardiovascular Catheter Ablation - instrumentation Catheters Echocardiography Female Follow-Up Studies Gender differences Heart Heart Diseases - prevention & control Heart surgery Humans Male Medical sciences Middle Aged Postoperative Complications - prevention & control Punctures - instrumentation Regression analysis Retrospective Studies Studies Thrombosis - blood Thrombosis - prevention & control Treatment Outcome |
| title | Safety of Lower Activated Clotting Times During Atrial Fibrillation Ablation Using Open Irrigated Tip Catheters and a Single Transseptal Puncture |
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