Femoral vascular complications following catheter ablation of atrial fibrillation.
BACKGROUND
Femoral vascular complications remain a significant complication of catheter ablation of atrial fibrillation as a result of peri-procedural anticoagulation protocols.


OBJECTIVE
We investigated the effect of three different anti-coagulation regimens on the incidence of femoral vascular complications following AF ablation over a 4 year period.


METHODS
We performed 603 catheter ablations in 539 patients from January 2004 to January 2008. All patients were started on coumadin immediately after procedure and received enoxaparin at 1 mg/kg 4 h post procedure and again 12 h later. Three protocols for enoxaparin, administered 12 hourly, were used post-procedure: Protocol A--1 mg/kg x ten doses; Protocol B--1 mg/kg x six doses, and Protocol C--0.5 mg/kg x six doses. We documented occurrence of femoral vascular complications prior to discharge and at the 1 month post-op visit using a prospective database. A femoral vascular complication was defined as hematoma requiring prolonged hospitalization, blood transfusion or surgical intervention.


RESULTS
There were 21 femoral vascular complications during the study period. The rate of complication fell from 5.7% (protocol A) to 1.6% (protocol C) (p < 0.03). We attribute the decrease in complication rate to the shorter anticoagulation protocol, as the reduction remained significant regardless of variation in catheter sizes. There were no new cerebral vascular events with the lower enoxaparin protocols.


CONCLUSIONS
A shorter course of post procedure anticoagulation protocol can reduce femoral complications without contributing to increased risk of thromboembolic events.
Prudente
Liza A
LA
University of Virginia Health System, Box 801461, 1215 Lee Street, Charlottesville, VA, 22908, USA. Lap4n@virginia.edu
Moorman
J Randall
JR
Lake
Douglas
D
Xiao
Yuping
Y
Greebaum
Heather
H
Mangrum
J Michael
JM
DiMarco
John P
JP
Ferguson
John D
JD
D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D005263:Femoral Artery; D006406:Hematoma / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D014768:Virginia / Q000453:epidemiology
D000925:Anticoagulants; D017984:Enoxaparin