title: Real-life experience with a new anticoagulation regimen for patients undergoing left-sided ablation procedures.
abstract: BACKGROUND
  Current guidelines for anticoagulation during left-sided procedures recommend the administration of unfractionated heparin (UFH) with an initial bolus of 50-100 U/kg, followed by continuous infusion to maintain an activated clotting time (ACT) ≥ 300 s. Our objective was to compare the effectiveness of this standard regimen (100 U/kg bolus) to a more aggressive approach (200 U/kg bolus).
  
  
  METHODS
  We collected data on a series of consecutive patients undergoing left sided ablation procedures. Patients with an INR ≥2.0 on the day of the procedure were excluded. Procedural anticoagulation was performed using one of two UFH regimens: 1) 100 U/kg bolus, followed by 10 U/kg/hour infusion or 2) 200 U/kg bolus, followed by 20 U/kg/hour infusion. ACT was measured 10 min after the second bolus and then controlled every 20 min. Heparin was titrated throughout the procedure to maintain an ACT 300-400 s.
  
  
  RESULTS
  145 consecutive patients were included in the study: 34 received an initial bolus of 100 U/kg and 111 received 200 U/kg. The mean time required to reach an ACT ≥300 s was 15.25 min (95% CI 12.97-17.03) in the 200 U/kg group and 51.23 min (95% CI 40.65-61.81) in the 100 U/kg group (p < 0.001). There was no difference between groups with regard to thromboembolic or hemorrhagic complications.
  
  
  CONCLUSIONS
  Current anticoagulation guidelines for left-sided ablation procedures almost universally fail to achieve an initial ACT ≥300 s. A 200 U/kg heparin bolus is much more effective to promptly reach the target ACT, with a low rate of overshoot.
authors.affiliation: Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Québec, Canada. Electronic address: charles.dussault@usherbrooke.ca.
authors.forename: Charles
authors.initials: C
authors.lastname: Dussault
authors.affiliation: Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Québec, Canada.
authors.forename: Santiago
authors.initials: S
authors.lastname: Rivera
authors.affiliation: Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Québec, Canada.
authors.forename: Mariano
authors.initials: M
authors.lastname: Badra-Verdu
authors.affiliation: Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Québec, Canada.
authors.forename: Felix
authors.initials: F
authors.lastname: Ayala-Paredes
authors.affiliation: Centre Hospitalier Universitaire de Sherbroke, Sherbrooke, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roux
keywords: Ablation; Arrhythmia; Heparin