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

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Transseptal catheterization is essential for atrial fibrillation (AF) ablation but carries a risk of thromboembolism.
• Transseptal sheaths (TSS) have been proposed for continuous heparinized saline flushing to mitigate this risk.
• This study investigated the safety and effectiveness of a simplified TSS management strategy to reduce thrombus formation.

Purpose of the Study:

• To evaluate the efficacy of a simple transseptal sheath management technique in preventing thrombus development.
• To assess the safety and effectiveness of high-concentration heparinized saline infusion for transseptal sheaths during AF ablation.

Main Methods:

• A retrospective multi-center study and a prospective single-center study were conducted on AF patients undergoing radiofrequency ablation.
• Transseptal sheaths and dilators were flushed with high-concentration heparinized saline (20 U/mL).
• Activated clotting time (≥300 s) was maintained with heparin infusion, and TSS were aspirated and re-perfused with heparinized saline throughout the procedure.

Main Results:

• In the retrospective study (4765 patients, 5367 procedures), 10 (0.19%) procedures had perioperative thromboembolic complications; no acute strokes occurred.
• The prospective study (127 procedures) showed no sheath- or catheter-associated thrombus detected by intracardiac echocardiography, with zero perioperative thromboembolic complications.
• No hemorrhagic cerebrovascular complications were observed in either study.

Conclusions:

• High-concentration heparinized saline infusion alone for transseptal sheaths is a safe and effective method during AF ablation.
• This simplified TSS management approach successfully avoids sheath-associated thrombus formation.
• The technique is beneficial for reducing thromboembolic risks in interventional procedures.