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High-flow perfusion of sheaths for prevention of thromboembolic complications during complex catheter ablation in the
Bruno Cauchemez1, Fabrice Extramiana, Simon Cauchemez
1Department of Cardiology, Lariboisière Hospital, Paris, France. bruno.cauchemez@lrb.ap-hop-paris.fr
Insights
High-flow transseptal sheath perfusion significantly reduces stroke risk during complex left atrial ablation for atrial fibrillation (AF) and tachycardia. Low-flow perfusion is associated with a 17-fold increased risk of thromboembolic complications.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Thromboembolic complications during complex left atrial (LA) ablation procedures remain poorly understood.
- Investigating factors influencing these events is crucial for patient safety.
Purpose of the Study:
- To determine the impact of transseptal sheath perfusion rate on thromboembolic complication incidence.
- To assess the efficacy of different perfusion rates during catheter ablation for atrial fibrillation (AF) or LA macroreentrant tachycardia.
Main Methods:
- Analysis of clinical and procedural data from 153 ablations in 86 patients.
- Comparison of low-flow (3 mL/hour) versus high-flow (180 mL/hour) transseptal sheath perfusion.
- Utilized map-guided pulmonary vein isolation and 3D electroanatomic mapping.
Main Results:
- Five patients (6%) experienced cerebral thromboembolic complications, all with low-flow perfusion.
- Sheath perfusion rate and procedure duration were significantly associated with stroke (P=0.013 and P=0.001).
- Low-flow perfusion increased stroke risk 17-fold (OR 17.26; P=0.04), remaining the sole significant risk factor after multivariable analysis.
Conclusions:
- Transseptal sheath perfusion rate is a critical factor in mitigating stroke risk during complex LA ablation.
- Continuous high-flow perfusion is an effective strategy for preventing thromboembolic complications in these procedures.
Introduction:
Mechanisms for thromboembolic complications during complex ablation procedures in left atrium (LA) have not been defined. The aim of this study was to determine the effect of the perfusion rate of the transseptal sheath on the incidence of thromboembolic complications during catheter ablation for atrial fibrillation (AF) or LA macroreentrant tachycardia.
Methods And Results:
We analyzed clinical and procedural data from 86 consecutive patients (153 procedures) referred for catheter ablation of AF (74 patients) or LA macroreentrant tachycardia (12 patients). The transseptal sheath was continuously perfused at a low flow rate (3 mL/hour) for the first 32 patients and at a high flow rate (180 mL/hour) for the subsequent 54 patients. Ablation was mainly performed using map-guided isolation of pulmonary veins for AF and three-dimensional electroanatomic mapping for LA macroreentrant tachycardia. Five patients (6% of patients and 3.5% of procedures) developed a cerebral thromboembolic complication, all during procedures using low-flow perfusion. Sheath perfusion rate and total procedure duration were the two variables significantly associated with the occurrence of stroke (P = 0.013 and 0.001, respectively). After adjustment in a multivariable analysis, sheath perfusion rate remained the only risk factor for stroke. The risk was 17 times higher using low-flow than high-flow perfusion (odds ratio 17.26, 95% confidence interval 1.14-260.81, P = 0.04). No other clinical or procedural parameters had any significant effect.
Conclusion:
Sheath perfusion rate is an important determinant of the risk factor for stroke during complex LA ablation procedures. Continuous high-flow perfusion appears to be effective in preventing this complication.
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