Predictors of local venous complications resulting from electrophysiological procedures.
BACKGROUND
Thromboembolic complications resulting from radiofrequency catheter ablation (RFCA) have an overall incidence of 0.6%. Multiple intracardiac catheters are often necessary for electrophysiological study and RFCA therapy. Therefore, the placement of multiple venous sheaths in one femoral vein is always required for multiple intracardiac catheter insertion. The safety of the placement of multiple separate venous sheaths has been studied previously in a non-randomized study, but the placement of multiple sheaths via one venous line has not been fully studied.


RESULTS
A randomized clinical trial was conducted with a total of 200 patients. We studied the safety of placing multiple sheaths via one venous line, and the effect of heparin on deep vein thrombosis (DVT) and on in situ thrombosis. DVT was not seen in our patients. We observed a significant decrease in the rate of in situ thrombosis in patients who received heparin during the procedure (28% vs 11%, p = 0.04). The type of cannulation changed the in situ thrombosis rate independently of the heparinization protocol. The rate of in situ thrombosis was higher when placing sheaths via one venous line regardless of the heparinization protocol used (16% vs 6%, p = 0.1 for the group on heparin, and 38% vs 18%, p = 0.04 for the other group). In the group cannulated with only one venous line (100 patients), heparinization significantly decreased the rate of in situ thrombosis (16% vs 38%, p = 0.023), but there was an insignificant decrease in the separate cannulation group (6% vs 18%, p = 0.12). Advanced age had no effect on thrombosis. Surprisingly, there was a significantly greater rate of in situ thrombosis (not DVT) among women than among men (26% vs 11%, p = 0.01), regardless of the heparinization protocolor the type of cannulation.


CONCLUSIONS
Given the local venous complications and DVT after electrophysiological procedures, heparinization is not necessary for right-sided electrophysiological procedures. In situ thrombosis is a minor complication that can be reduced by heparinization in patients undergoing one-line cannulation and in women during longer procedures.
Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Tehran, Iran. Alizadeh_73@yahoo.com
Abolfath
A
Alizadeh
Amir Hosein
AH
Yazdi
Mohammad
M
Kafi
Mohammad Assadian
MA
Rad
Mehdi
M
Moradi
Zahra
Z
Emkanjoo
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017115:Catheter Ablation / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007492:Iran; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013617:Tachycardia, Supraventricular / Q000628:therapy; D017180:Tachycardia, Ventricular / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D014693:Ventricular Fibrillation / Q000628:therapy
D000925:Anticoagulants; D006493:Heparin