Document Detail

Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation.
MedLine Citation:
PMID:  18568395     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: We reviewed our experience in managing intracardiac ultrasound-detected left atrial thrombus and analyzed the impact of the timing of heparin therapy on thrombus incidence. METHODS AND RESULTS: We identified 508 patients undergoing ablation procedures for atrial fibrillation in which intracardiac ultrasound was used. All patients received unfractionated heparin during the procedure: 31 patients before the first transseptal puncture (preTS1), 257 between the first and second transseptal punctures (TS1-TS2), and 220 following both punctures (postTS2). By using intracardiac echocardiography (ICE), thrombus was detected in 30 of these 508 patients (5.9%). Of these, 29 were in the left atrium and constituted our study group. In 21 patients, the thrombi were successfully aspirated from the left atrium using strong suction through the transseptal sheath. All patients in whom thrombi were aspirated did well without neurological event or death. When patients received heparin therapy either preTS1 or TS1-TS2, there was a significant decrease in the occurrence of ICE-detected left atrial thrombus compared with those who received heparin postTS2 (0 of 31 patients (0%) preTS, 9 of 257 (3.5%) TS1-TS2, and 20 of 220 (9.1%) postTS2; (preTS1 vs postTS2, p = 0.01; preTS2 [preTS1 and TS1-TS2] vs postTS2, p < 0.001). CONCLUSION: Early administration of intravenous heparin, specifically before transseptal puncture, decreases the incidence of left atrial thrombi.
Charles J Bruce; Paul A Friedman; Om Narayan; Thomas M Munger; Stephen C Hammill; Douglas L Packer; Samuel J Asirvatham
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Publication Detail:
Type:  Journal Article     Date:  2008-06-21
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  22     ISSN:  1383-875X     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-07-24     Completed Date:  2008-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  211-9     Citation Subset:  IM    
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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MeSH Terms
Anticoagulants / administration & dosage
Atrial Fibrillation / complications,  surgery*,  ultrasonography
Catheter Ablation / adverse effects*
Echocardiography / methods
Heart Atria / drug effects,  surgery,  ultrasonography
Heart Diseases / etiology,  prevention & control*,  ultrasonography*
Heparin / administration & dosage*
Middle Aged
Premedication / methods*
Retrospective Studies
Thrombosis / etiology,  prevention & control*,  ultrasonography*
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin

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