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Implementation of a Standardized Nurse-Guided Heparinization Protocol Improves Anticoagulation During Left Atrial
Vanessa Sciacca1, Jasmin Retzlaff1, Martin Braun1
1Department of Electrophysiology, Heart- and Diabetescenter NRW, Ruhr-University Bochum, Bochum, Germany.
Journal of Cardiovascular Electrophysiology
|May 18, 2026
Summary
A standardized, nurse-led heparin protocol improved anticoagulation during atrial fibrillation (AF) and atrial tachycardia (AT) ablations. This approach ensured faster, more consistent therapeutic anticoagulation without increasing complications.
Area of Science:
- Cardiology
- Electrophysiology
- Nursing Practice
Background:
- Effective intraprocedural anticoagulation is critical for catheter ablation procedures in atrial fibrillation (AF) and atrial tachycardia (AT).
- Assessing anticoagulation performance and safety is essential during these interventions.
Purpose of the Study:
- To evaluate a novel, standardized, nurse-led heparin protocol for intraprocedural anticoagulation during AF and AT ablation.
- To compare the anticoagulation performance and safety of this protocol against operator-guided heparin administration.
Main Methods:
- A comparative study involving consecutive patients undergoing AF or AT ablation.
- Implementation of a standardized heparinization protocol managed by electrophysiology nursing staff (study group) versus operator-discretion heparin administration (control group).
- Monitoring of activated clotting time (ACT) every 20 minutes, with nurses autonomously managing repeat heparin doses in the study group.
Main Results:
- The nurse-led protocol group achieved therapeutic ACT ( > 300s) more frequently (84.6% vs. 59.7%, p < 0.0001) and faster than the control group.
- Fewer subtherapeutic ACT values were observed in the study group.
- Excessive anticoagulation (ACT > 400s) was less common in the study group (2.0% vs. 5.0%, p = 0.0027), with similar low complication rates in both groups.
Conclusions:
- A standardized, nurse-led heparinization protocol significantly enhances the speed, consistency, and precision of intraprocedural anticoagulation during left atrial ablation.
- This protocol achieves therapeutic anticoagulation targets effectively without elevating procedural complication rates.
- Nurse-led protocols represent a safe and effective strategy for managing anticoagulation in electrophysiology procedures.
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