title: Short-Term Heparin Kinetics during Catheter Ablation of Atrial Fibrillation.
abstract: BACKGROUND
  Percutaneous catheter ablation of atrial fibrillation (CA-AF) is a treatment option for symptomatic drug-refractory atrial fibrillation (AF). CA-AF carries a risk for thromboembolic complications that has been minimized by the use of intraprocedural intravenous unfractionated heparin (UFH). The optimal administration of UFH as well as its kinetics are not well established and need to be precisely determined.
  
  
  RESULTS
  A total 102 of consecutive patients suffering from symptomatic drug-refractory AF underwent CA-AF. The mean age was 61 ± 10 years old. After transseptal puncture of the fossa ovalis, weight-adjusted UFH bolus (100 U/kg) was infused. A significant increase in activated clotting time (ACT) was observed from an average value of 100 ± 27 seconds at baseline, to 355 ± 94 seconds at 10 min (T10), to 375 ± 90 seconds at 20 min (T20). Twenty-four patients failed to reach the targeted ACT value of ≥300 seconds at T10 and more than half of these remained with subtherapeutic ACT values at T20. This subset of patients showed similar clinical characteristics and amount of UFH but were more frequently prescribed preprocedural vitamin K1 than the rest of the study population.
  
  
  CONCLUSIONS
  In a typical intervention setting, UFH displays unexpected slow anticoagulation kinetics in a significant proportion of procedures up to 20 minutes after infusion. These findings support the infusion of UFH before transseptal puncture or any left-sided catheterization with early ACT measurements to identify patients with delayed kinetics. They are in line with recent guidelines to perform CA-AF under therapeutic anticoagulation.
authors.affiliation: Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gabus
authors.affiliation: Department of Cardiology, University Hospital Rangueil, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Rollin
authors.affiliation: Department of Cardiology, University Hospital Rangueil, Toulouse, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maury
authors.affiliation: Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Andrei
authors.initials: A
authors.lastname: Forclaz
authors.affiliation: Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pascale
authors.affiliation: St George's, University of London, London, United Kingdom.
authors.forename: Harshil
authors.initials: H
authors.lastname: Dhutia
authors.affiliation: Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bisch
authors.affiliation: Service of Cardiology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Pruvot
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000097:blood* / Q000601:surgery*; D001682:Biological Availability; D001777:Blood Coagulation / Q000187:drug effects; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D007700:Kinetics; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D013923:Thromboembolism / Q000097:blood / Q000517:prevention & control*; D016896:Treatment Outcome; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: anticoagulation; atrial fibrillation; catheter ablation; thromboembolism; unfractionated heparin