title: Effectiveness of a strategy to reduce major vascular complications from catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Fnu
authors.initials: F
authors.lastname: Abhishek
authors.forename: Edwin Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Conor
authors.initials: C
authors.lastname: Barrett
authors.forename: Stephan
authors.initials: S
authors.lastname: Danik
authors.forename: Dan
authors.initials: D
authors.lastname: Blendea
authors.forename: Christina
authors.initials: C
authors.lastname: Correnti
authors.forename: Zaka
authors.initials: Z
authors.lastname: Khan
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000601:surgery*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D017115:Catheter Ablation; D005260:Female; D005268:Femoral Vein; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009339:Needles; D011183:Postoperative Complications / Q000517:prevention & control*; D011677:Punctures; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin