Burstein Barry, Barbosa Rodrigo S, Samuel Michelle, Kalfon Eli, Philippon François, Birnie David, Mangat Iqwal, Redfearn Damian, Sandhu Roopinder, Macle Laurent, Sapp John, Verma Atul, Healey Jeff S, Becker Giuliano, Chauhan Vijay, Coutu Benoit, Roux Jean-François, Leong-Sit Peter, Andrade Jason G, Veenhuyzen George D, Joza Jacqueline, Bernier Martin, Essebag Vidal
McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
Hospital Albert Sabin, Rua Doutor Edgar Carlos Pereira, 600 - Santa Teresa, Juiz de Fora, MG, 36020-200, Brazil.
J Interv Card Electrophysiol. 2018 Dec;53(3):357-363. doi: 10.1007/s10840-018-0461-9. Epub 2018 Oct 8.
Femoral venous access is required for most electrophysiology procedures. Limited data are available regarding post-procedure venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE). Potential preventative strategies are unclear. We aimed to survey Canadian centers regarding incidence of VTE and strategies for prevention of VTE after procedures that do not require post-procedure anticoagulation.
An online survey was distributed to electrophysiologists representing major Canadian EP centers. Participants responded regarding procedural volume, incidence of VTE post-procedure, and their practice regarding pharmacological and non-pharmacological peri-procedural VTE prophylaxis.
The survey included 17 centers that performed a total of 6062 procedures in 2016. Ten patients (0.16%) had VTE (including 9 DVTs and 6 PEs) after diagnostic electrophysiology studies and right-sided ablation procedures excluding atrial flutter. Five centers (41.6%) administered systemic intravenous heparin during both diagnostic electrophysiology studies and right-sided ablation procedures. For patients taking oral anticoagulants, 10 centers (58.8%) suspend therapy prior to the procedure. Two centers (11.8%) routinely prescribed post-procedure pharmacologic prophylaxis for VTE. Four centers (23.5%) used compression dressings post-procedure and all prescribed bed rest for a maximum of 6 h. Of the variables collected in the survey, none were found to be predictive of VTE.
VTE is not a common complication of EP procedures. There is significant variability in the strategies used to prevent VTE events. Future research is required to evaluate strategies to reduce the risk of VTE that may be incorporated into EP practice guidelines.
大多数电生理手术需要股静脉通路。关于术后静脉血栓栓塞（VTE），特别是深静脉血栓形成（DVT）和肺栓塞（PE）的数据有限。潜在的预防策略尚不清楚。我们旨在就VTE的发生率以及在不需要术后抗凝的手术后预防VTE的策略对加拿大各中心进行调查。
向代表加拿大主要电生理中心的电生理学家发放了一份在线调查问卷。参与者就手术量、术后VTE的发生率以及他们在围手术期进行药物和非药物VTE预防的做法进行了回复。
该调查包括17个中心，这些中心在2016年共进行了6062例手术。在诊断性电生理研究和除心房扑动外的右侧消融术后，有10例患者（0.16%）发生了VTE（包括9例DVT和6例PE）。5个中心（41.6%）在诊断性电生理研究和右侧消融术中均给予全身性静脉肝素。对于服用口服抗凝剂的患者，10个中心（58.8%）在手术前暂停治疗。2个中心（11.8%）常规为术后VTE开具药物预防处方。4个中心（23.5%）在术后使用加压敷料，并且所有中心都规定最多卧床休息6小时。在调查收集的变量中，没有发现任何一个可预测VTE。
VTE不是电生理手术的常见并发症。预防VTE事件所采用的策略存在很大差异。需要未来的研究来评估可纳入电生理实践指南的降低VTE风险的策略。
