Abstract 15338: A Novel Approach to Tailor Heparin Dosage During Ablation of Atrial Fibrillation: An Assessment of Sensitivity to Unfractionated Heparin
Background: Heparinization during ablation of atrial fibrillation (AF) is not necessarily easy due to individual variations in the sensitivity to heparin. We aimed to develop an approach for determining heparin requirements quickly during AF ablation.
Methods and Results: Patients skipped the last dose of novel anticoagulants (NOACs) before AF ablation (dabigatran 150 mg BID, N=110; apixaban 5 mg BID, N=92; rivaroxaban 15 mg QD, N=75), and were given an overnight unfractionated heparin bridging at an administration rate of 10000 U/24h. The ACT was measured just before the initial heparin injection (baseline ACT) and thereafter every 10 minutes. A bolus of heparin was infused based on each measurement result. No intergroup differences were noted in the baseline ACT, time to achieve a target ACT (300 msec), and total heparin requirement. We created a multiple logistic model to determine the ACT measured after an initial heparin injection (2nd ACT), in which the baseline ACT (β=0.7; P <0.001), initial heparin dosage (β=0.4; P <0.001), and NOAC type (β=0.19; P=0.02) were independent determinants, with an excellent coefficient of determinants (R2=0.6). The 2nd ACT within ±50 sec of the target ACT was achieved in 82.0% of the patients by applying an inverse prediction with this logistic model.
Conclusion: The interpatient variation in the baseline ACT may reflect the sensitivity to unfractionated heparin in each individual. Measuring the ACT after an overnight heparin bridging thus may be helpful to determine the initial heparin dosage.
Author Disclosures: A. Sairaku: None. Y. Nakano: None. Y. Kihara: None.
- © 2016 by American Heart Association, Inc.