Anticoagulation protocols during catheter ablation for atrial fibrillation in the elderly
10.3969/j.issn.1009-0126.2025.01.003
- VernacularTitle:导管射频消融治疗老年心房颤动患者术中抗凝方案研究
- Author:
Shixing LI
1
;
Jian LI
;
Chuang ZHANG
;
Tong ZHAO
;
Qian XIN
;
Xiangmin SHI
Author Information
1. 100048 北京,解放军总医院第六医学中心心血管病医学部
- Publication Type:Journal Article
- Keywords:
atrial fibrillation;
catheter ablation;
anticoagulants
- From:
Chinese Journal of Geriatric Heart Brain and Vessel Diseases
2025;27(1):9-12
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the results of different perioperative anticoagulation protocols for elderly patients with atrial fibrillation(AF)undergoing catheter radiofrequency ablation in our center.Methods A total of 197 elderly AF patients undergoing catheter radiofrequency ablation by a single operator in the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2021 to December 2023 were retrospectively recruited,and the results of relevant exami-nations were collected.Based on the use of different direct oral anticoagulants,they were divided into dabigatran(n=125)and rivaroxaban(n=72)groups.During the procedure,the appropriate dose of unfractionated heparin was administered according to the initial activated clotting time(ACT)with a self-made formula.The time and rate of ACT were recorded,and perioperative ad-verse reactions such as bleeding and thrombosis were observed.Results There were no statistical differences between the two groups in baseline data,including age,gender,BMI,medical history,CHA2DS2-VASc score,HAS-BLED score,and left atrial anteroposterior diameter(P＞0.05).The baseline ACT value was obviously shorter(149.73+23.52 s vs 157.91±24.58 s,P=0.032),the initial heparin dose was significantly higher(0.71±0.12 mg/kg vs 0.65±0.13 mg/kg,P=0.031),and the rate of ACT reaching the target within 15 min was notably lower(60％vs 74％,P＜0.05)in the dabigatran group than the rivaroxaban group.But no significant difference was observed in the rate of ACT reaching the target in 45 min after additional heparin administration according to the formula(86％vs 88％,P＞0.05).The dabigatran group used higher dose of heparin during the procedure than the rivaroxaban group(0.99±0.30 mg/kg vs 0.85±0.31 mg/kg,P=0.009).Peri-cardial effusion was observed in one patient of the rivaroxaban group,and hematoma at the site of femoral vein puncture was seen in one patients of the dabigatran group in 1 d after procedure,which was treated surgically.No other severe complications occurred.Conclusion For elderly pa-tients with AF undergoing catheter ablation therapy,continuous perioperative anticoagulation and individualized application of unfractionated heparin based on initial ACT value can rapidly achieve ACT targets and improve anticoagulation efficacy.
