Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
J Cardiovasc Electrophysiol. 2018 Apr;29(4):584-590. doi: 10.1111/jce.13418. Epub 2018 Jan 25.
Ablation in the left ventricle (LV) is associated with a risk of thromboembolism. There are limited data on the use of specific thromboembolic prophylaxis strategies postablation. We aimed to evaluate a thromboembolic prophylaxis protocol after ventricular tachycardia (VT) ablation.
The index procedures of 217 patients undergoing ablation for infarct-related VT with open irrigated-tip catheters were included. Patients with large LV endocardial ablation area (>3 cm between ablation lesions) were started on low-dose, slowly escalating unfractionated heparin (UFH) infusion 8 hours after access hemostasis, followed by 3 months of anticoagulation. Patients with less extensive ablation were treated only with antiplatelet agents postablation. Postablation bridging anticoagulation was used in 181 (83%) patients. Of them, 11 (6%) patients experienced bleeding events (1 required endovascular intervention) and 1 (0.6%) experienced lower extremity arterial embolism requiring vascular surgery. Systemic anticoagulation was prescribed in 190 (89%) of 214 patients discharged from the hospital (warfarin in 98%), while the rest received single- or dual-antiplatelet therapy alone. Patients treated with an anticoagulant had significantly longer radiofrequency time compared to patients treated with antiplatelet agents only. One (0.5%) of the patients treated with oral anticoagulation experienced major bleeding 2 weeks postablation. No thromboembolic events were documented in either the anticoagulation or the "antiplatelet only" group postdischarge.
A slowly escalating bridging regimen of UFH, followed by 3 months of oral anticoagulation, is associated with low thromboembolic and bleeding risks after infarct-related VT ablation. In the absence of extensive ablation, antiplatelet therapy alone is reasonable.
左心室 (LV) 的消融与血栓栓塞风险相关。消融后使用特定的血栓预防策略的数据有限。我们旨在评估室性心动过速 (VT) 消融后的血栓预防方案。
共纳入 217 例行梗死相关 VT 消融的患者的索引程序。对于 LV 心内膜消融面积较大 (>消融病变之间 3cm) 的患者，在止血后 8 小时开始低剂量、逐渐增加的未分级肝素 (UFH) 输注，随后进行 3 个月抗凝治疗。对于消融范围较小的患者，消融后仅接受抗血小板治疗。181 例（83%）患者在消融后进行桥接抗凝治疗。其中，11 例（6%）患者发生出血事件（1 例需要血管内介入治疗），1 例（0.6%）患者发生下肢动脉栓塞，需要血管手术。190 例（89%）出院患者接受了全身抗凝治疗（98%为华法林），而其余患者接受了单独的抗血小板治疗或双联抗血小板治疗。接受抗凝治疗的患者的射频时间明显长于仅接受抗血小板治疗的患者。1 例（0.5%）接受口服抗凝治疗的患者在消融后 2 周发生大出血。出院后，抗凝组或“仅抗血小板组”均未发生血栓栓塞事件。
在梗死相关 VT 消融后，使用 UFH 进行逐渐增加的桥接治疗，随后进行 3 个月的口服抗凝治疗，与低血栓栓塞和出血风险相关。在没有广泛消融的情况下，单独使用抗血小板治疗是合理的。
