Abhishek Fnu, Heist Edwin Kevin, Barrett Conor, Danik Stephan, Blendea Dan, Correnti Christina, Khan Zaka, Ruskin Jeremy N, Mansour Moussa
Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
J Interv Card Electrophysiol. 2011 Apr;30(3):211-5. doi: 10.1007/s10840-010-9539-8. Epub 2011 Feb 19.
Vascular access site complications are among the most frequently observed complications after catheter ablation of atrial fibrillation (AF). We sought to determine whether implementation of a three-point strategy would reduce major vascular complications resulting from catheter ablation of atrial fibrillation.
Three hundred twenty-four consecutive patients undergoing catheter ablation of AF were studied: 162 in each group (with and without the test strategy). The three-point test strategy included the following: (1) performing the procedure on Warfarin with an INR from 2.0 to 3.5 (mean INR of 2.44), rather than stopping Warfarin prior to the procedure and bridging the patient back to Warfarin with low molecular heparin, (2) using a small 21 G needle to obtain femoral vein access rather than a larger 18 G needle, and (3) eliminating the use of femoral arterial access. Major vascular complications were defined as complications requiring either blood transfusion or surgical/percutaneous repair.
Major vascular complications were identified in 6/162 (3.7%) of the control patients without the strategy listed above compared to 0/162 (0%) in the test patients with implementations of this strategy (p = 0.03). The frequency of other complications was comparable between the two groups (tamponade requiring drainage: 1/162 control, 1/162 test; pericardial effusion not requiring drainage: 0/162 control, 1/162 test; transient ischemic attack: 1/162 control and 1/162 test; stroke: 1/162 control, 0/162 test): (p = NS for each).
A three-point strategy including performing procedures with therapeutic Warfarin, using a small gauge needle to obtain vascular access and eliminating femoral arterial access significantly reduced major vascular access complications and did not affect other major complications, during catheter ablation of AF. Implementation of this strategy may be useful to reduce groin complications resulting from AF ablation.
血管穿刺部位并发症是心房颤动（AF）导管消融术后最常见的并发症之一。我们试图确定实施三点策略是否会减少房颤导管消融导致的主要血管并发症。
对324例连续接受房颤导管消融的患者进行研究：每组162例（采用和不采用试验策略）。三点试验策略包括：（1）在国际标准化比值（INR）为2.0至3.5（平均INR为2.44）的华法林治疗期间进行手术，而不是在手术前停用华法林并用低分子肝素使患者重新使用华法林，（2）使用21G小针头获取股静脉通路而不是更大的18G针头，以及（3）不使用股动脉通路。主要血管并发症定义为需要输血或手术/经皮修复的并发症。
未采用上述策略的对照组患者中有6/162（3.7%）发生主要血管并发症，而采用该策略的试验组患者中为0/162（0%）（p = 0.03）。两组之间其他并发症的发生率相当（需要引流的心包填塞：对照组1/162，试验组1/162；不需要引流的心包积液：对照组0/162，试验组1/162；短暂性脑缺血发作：对照组1/162，试验组1/162；中风：对照组1/162，试验组0/162）：（每项p = 无显著性差异）。
在房颤导管消融过程中，包括在治疗性华法林治疗期间进行手术、使用小口径针头获取血管通路以及不使用股动脉通路的三点策略显著减少了主要血管穿刺并发症，且不影响其他主要并发症。实施该策略可能有助于减少房颤消融引起的腹股沟并发症。
