Purpose
Cardiac catheter ablations are an established treatment for supraventricular tachycardia
(SVT) involving prolonged cannulation of the common femoral vein with multiple catheters.
This study aimed to identify the risk of deep vein thrombosis (DVT) by studying the
frequency of this complication after catheter ablation.
Methods
This was a prospective multi-centre cohort study of patients undergoing cardiac ablation
for atrioventricular nodal re-entry tachycardia or right-sided accessory atrioventricular
connection. Those taking anticoagulation or antiplatelet therapy prior to the procedure
were excluded. Following the procedure, bilateral venous duplex ultrasonography from
the popliteal vein to the inferior vena cava for DVT was undertaken at 24 hours and
between 10 to 14 days.
Results
Eighty (80) patients (mean age 47.6 yrs [SD 13.4] with 67% female) underwent cardiac
ablation (median duration 70 mins). Seven (7) patients developed acute DVT in either
the femoral or external iliac vein of the intervention leg, giving a frequency of
8.8% (95% CI 3.6–17.2%). No thrombus was seen in the contralateral leg (p=0.023).
An elevated D-dimer prior to the procedure was significantly more frequent in patients
developing DVT (42.9% vs 4.1%, p=0.0081; OR 17.0). No other patient or procedural
characteristics significantly influenced the risk of DVT.
Conclusion
In patients without peri-procedural anticoagulation catheter ablation precipitated
DVT in the catheterised femoral or iliac veins in 8.8% of patients. Peri-procedure
prophylactic anticoagulation may be considered for all patients undergoing catheter
ablation for SVT.
Clinical Trial Registration
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias).Circulation. 2003; 108: 1871-1909
- National Audit of cadiac ablation 2013-14.https://bhrs.com/wp-content/uploads/2019/03/Ablation-Report-2013-14-version-9-Final1.pdfDate accessed: September , 2020
- National Audit of Cardiac Rhythm Management Devices and Ablation 2016/17 Summary Report.2019https://bhrs.com/wp-content/uploads/2019/07/CRM-Report-2016-2017.pdfDate accessed: September , 2020
- The Prevention of Venous Thromboembolism in Hospitalised Patients. Second report of Session 2004-05 (The Stationery Office) 2005.https://publications.parliament.uk/pa/cm200405/cmselect/cmhealth/99/99.pdfDate accessed: September , 2020
- Mortality from pulmonary embolism is decreasing in hospital patients.J R Soc Med. 2011; 104: 327-331
- Thrombogenicity of radiofrequency ablation procedures: what factors influence thrombin generation?.Europace. 2001; 3: 195-200
- Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures.Thromb Haemost. 2003; 90: 446-455
- Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms.Circulation. 1994; 89: 1074-1089
- Safety and outcomes of short-term multiple femoral venous sheath placement in cardiac electrophysiological study and radiofrequency catheter ablation.Jpn Heart J. 2004; 45: 257-264
- Current venous thromboembolism prevention practices following endovascular electrophysiological procedures in the UK: a retrospective study.Sultan Qaboos Univ Med J. 2018; 18: e374-e378
- Femoral vein thrombosis after right-sided electrophysiological procedures.J Interv Card Electrophysiol. 2013; 38: 155-158
- Prevention and treatment of lower limb deep vein thrombosis after radiofrequency catheter ablation: results of a prospective active controlled study.Sci Rep. 2016; 6: 28439
- Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS).Europace. 2015; 17: 1197-1214
- Does this patient have deep vein thrombosis?.JAMA. 2006; 295: 199-207
- NICE (2020) Venous thromboembolic diseases: diagnosis, management and thrombophilia testing.https://www.nice.org.uk/guidance/ng158Date accessed: September , 2020
- Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e419S-e496S
- Venous thromboembolism prophylaxis: do trial results enable clinicians and patients to evaluate whether the benefits justify the risk? Proceedings of an Ad Hoc Working Group Meeting.J Thromb Haemost. 2013; 11: 778-782
- A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients.Thromb Haemost. 2004; 91: 655-666
- Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery.J Thromb Haemost. 2007; 5: 1438-1443
- Asymptomatic postoperative deep vein thrombosis and the development of postthrombotic syndrome. A systematic review and meta-analysis.Thromb Haemost. 2005; 93: 236-241
- Risk factors for presence and severity of pulmonary embolism in patients with deep venous thrombosis.J Vasc Surg Venous Lymphat Disord. 2018; 6: 7-12
- Asymptomatic deep vein thrombosis is associated with an increased risk of death: insights from the APEX trial.Thromb Haemost. 2018; 118: 2046-2052
- Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients.Thromb Haemost. 2005; 93: 76-79
- Current status of venous thromboembolism development during the perioperative period for colorectal cancer, its prevention with enoxaparin, and monitoring methods.Ther Clin Risk Manag. 2019; 15: 791-802
- High incidence of occult femoral vein thrombosis related to multiple venous sheaths during electrophysiological studies.Heart. 2004; 90: 1061-1062
- Economic burden of long-term complications of deep vein thrombosis after total hip replacement surgery in the United States.Value Health. 2003; 6: 59-74
- Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism.
- The 1998 NASPE prospective catheter ablation registry.Pacing Clin Electrophysiol. 2000; 23: 1020-1028
- Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial.Circulation. 2014; 129: 2638-2644
- Oral apixaban for the treatment of acute venous thromboembolism.N Engl J Med. 2013; 369: 799-808
- Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: the post-arthroplasty screening study. A randomized, controlled trial.Ann Intern Med. 1997; 127: 439-445
Article info
Publication history
Published online: March 14, 2022
Accepted:
January 13,
2022
Received in revised form:
November 22,
2021
Received:
September 7,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
