Transseptal Sheath Perfused With High Concentration Heparinized Saline for Reducing Sheath-Associated Thrombus.

IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-03-01 Epub Date: 2024-12-10 DOI:10.1111/pace.15115
Juan Xu, Shi Peng, Yuanjun Sun, Zhenning Nie, Ya Zhen, Xiaomeng Yin, Xiaofeng Lu, Yan Liu, Xiaoyu Zhang, Dayang Huang, Shuai Guo, Yong Wei, Genqing Zhou, Yunlong Xia, Jun Li, Shaowen Liu, Songwen Chen
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引用次数: 0

Abstract

Background: Transseptal catheterization is critical for atrial fibrillation (AF) ablation but risks thromboembolism. Transseptal sheaths (TSS) were suggested for continuous heparinized saline solution flush. The safety and effectiveness of a simple TSS management to reduce sheath-associated thrombus development risk was investigated.

Methods: AF patients who underwent radiofrequency ablation with the simple TSS management were studied under a retrospective multi-center observation study and a prospective single-center observation study. TSS and dilators were washed and perfused with high concentration heparinized saline (20 u/mL). Immediately after two successful transseptal punctures, activated clotting time ≥300 s was maintained by heparin infusion. TSS aspiration with negative suction and re-perfusion with high concentration heparinized saline (20 u/mL) was performed for the remaining procedure before and after catheter withdrawal.

Results: A total of 4765 AF patients underwent 5367 ablation procedures were enrolled in the retrospective study, involving 156 (2.9% per procedure) complications. No acute stroke occurred during all the procedures. Perioperative thromboembolic complications occurred in 10 (0.21%) patients and in 10 (0.19%) procedures. Thromboembolic complications occurred within 24 h, between 24-48 h, and after 48 h post-procedure in six, two, and two patients, respectively. In the prospective observation study, neither sheath- nor catheter-associated thrombus were detected by the intracardiac echocardiography during all 127 procedures, without any perioperative thromboembolic complications. No hemorrhagic cerebrovascular complication was encountered in both observational studies.

Conclusion: For AF radiofrequency ablation, it was safe and effective for TSS high concentration heparinized saline infusion only. This approach could avoid sheath-associated thrombus for interventional procedures.

经间隔鞘灌注高浓度肝素化盐水减少鞘相关血栓。
背景:房颤(AF)消融术中经间隔置管是至关重要的,但有血栓栓塞的风险。建议使用经间隔鞘(TSS)进行持续的肝素化生理盐水冲洗。研究了简单TSS管理降低鞘相关血栓形成风险的安全性和有效性。方法:采用回顾性多中心观察研究和前瞻性单中心观察研究,对单纯TSS治疗下射频消融的AF患者进行研究。冲洗TSS和扩张器并用高浓度肝素化生理盐水(20u /mL)灌注。两次穿刺成功后,立即通过肝素输注维持激活凝血时间≥300 s。拔管前后分别行TSS负吸吸和高浓度肝素生理盐水(20 u/mL)再灌注。结果:共有4765例房颤患者接受了5367次消融手术,纳入回顾性研究,涉及156例(每次手术2.9%)并发症。所有手术过程中均未发生急性中风。10例(0.21%)患者和10例(0.19%)手术发生围手术期血栓栓塞并发症。6例、2例和2例患者分别在术后24小时、24-48小时和48小时后发生血栓栓塞性并发症。在前瞻性观察研究中,在所有127例手术中,心内超声心动图均未检测到鞘或导管相关血栓,无围手术期血栓栓塞并发症。两项观察性研究均未发生出血性脑血管并发症。结论:仅输注TSS高浓度肝素生理盐水射频消融AF是安全有效的。这种方法可以避免介入手术中出现鞘相关血栓。
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来源期刊
Pace-Pacing and Clinical Electrophysiology
Pace-Pacing and Clinical Electrophysiology 医学-工程:生物医学
CiteScore
2.70
自引率
5.60%
发文量
209
审稿时长
2-4 weeks
期刊介绍: Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
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