Abstract 17354: Prevalence of Right Atrial Thrombus on the Transeptal Sheaths Detected by Intracardiac Echocardiography During Catheter Ablation for Atrial Fibrillation While on Therapeutic Coumadin.
Introduction: The reported prevalence of left atrial thrombus formation on the transseptal sheath detected by ICE ranged from 5 to 10.3% in patients undergoing pulmonary vein isolation (PVI) for atrial fibrillation. The aim of our study was to report the prevalence of thrombus on the transeptal sheath placed in the right atrium before the transeptal access in patients undergoing PVI with different anticoagulation protocols.
Methods: Data from four centers performing catheter ablation of atrial fibrillation under ICE guidance and utilizing an open irrigated catheter have been collected. Before transeptal access and before administration of i.v. heparin, we assessed the prevalence of thrombus attached to the transeptal sheath placed in the right atrium.
Results: Data from 2773 patients were analyzed. 1749 patients underwent PVI without Coumadin discontinuation with a mean INR of 2.46 ± 0.32 while 1024 patients underwent PVI after Coumadin discontinuation 3 days preceding the PVI. In all patients the right atrial thrombus was detected by ICE during transeptal access or immediately after the first transeptal puncture. The prevalence of right atrial thrombus on the transeptal sheath was found in 9.0% (158 pts) of patients on ‘therapeutic” Coumadin before PVI and in 8.6% (88 pts) of patients off Coumadin before PVI (p= 0.694). In all cases the right thrombus was monitored during the whole procedure by ICE. No parameter included in the baseline characteristics of the patients was found to be a predictor of this finding.
Conclusions: Our study shows that a thrombus on the transeptal sheaths placed in the right atrium is detected by ICE in about 9% of the patients undergoing PVI despite a therapeutic “INR”. These results suggest that administration of i.v. heparin before transeptal access is required even in patients with “therapeutic” INR.
- © 2010 by American Heart Association, Inc.