Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk

Charo Bruce; Karan Saraf; Steven Rogers; Magdi El-Omar; Graeme Kirkwood; Nicholas F Kelland; Dinakshi Shah; Shajil Chalil; Catherine Fullwood; Matthew Wright; Shahnaz Jamil-Copley; David Fox; Khalid Abozguia; Jecko Thachil; Charles McCollum; Gwilym M Morris

doi:10.1016/j.hlc.2022.01.014

Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk

Charo Bruce, Karan Saraf, Steven Rogers, Magdi El-Omar, Graeme Kirkwood, Nicholas F Kelland, Dinakshi Shah, Shajil Chalil, Catherine Fullwood, Matthew Wright, Shahnaz Jamil-Copley, David Fox, Khalid Abozguia, Jecko Thachil, Charles McCollum, Gwilym M Morris

Research output: Contribution to journal › Article › peer-review

Abstract

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: https://clinicaltrials.gov/ct2/show/NCT03877770.

Original language	English
Pages (from-to)	1015-1022
Number of pages	8
Journal	Heart Lung and Circulation
Volume	31
Issue number	7
Early online date	14 Mar 2022
DOIs	https://doi.org/10.1016/j.hlc.2022.01.014
Publication status	Published - 1 Jul 2022

Keywords

Biomarker
Catheter ablation
Complication
Supraventricular tachycardia
Thrombosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.hlc.2022.01.014

Cite this

Bruce, C., Saraf, K., Rogers, S., El-Omar, M., Kirkwood, G., Kelland, N. F., Shah, D., Chalil, S., Fullwood, C., Wright, M., Jamil-Copley, S., Fox, D., Abozguia, K., Thachil, J., McCollum, C., & Morris, G. M. (2022). Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk. Heart Lung and Circulation, 31(7), 1015-1022. https://doi.org/10.1016/j.hlc.2022.01.014

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title = "Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk",

abstract = "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: https://clinicaltrials.gov/ct2/show/NCT03877770.",

keywords = "Biomarker, Catheter ablation, Complication, Supraventricular tachycardia, Thrombosis",

author = "Charo Bruce and Karan Saraf and Steven Rogers and Magdi El-Omar and Graeme Kirkwood and Kelland, {Nicholas F} and Dinakshi Shah and Shajil Chalil and Catherine Fullwood and Matthew Wright and Shahnaz Jamil-Copley and David Fox and Khalid Abozguia and Jecko Thachil and Charles McCollum and Morris, {Gwilym M}",

note = "Funding Information: A research grant from of Bristol Myers Squibb , a grant from the British Heart Foundation , and study funding from NIHR . Publisher Copyright: {\textcopyright} 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)",

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month = jul,

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doi = "10.1016/j.hlc.2022.01.014",

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Bruce, C, Saraf, K, Rogers, S, El-Omar, M, Kirkwood, G, Kelland, NF, Shah, D, Chalil, S, Fullwood, C, Wright, M, Jamil-Copley, S, Fox, D, Abozguia, K, Thachil, J, McCollum, C & Morris, GM 2022, 'Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk', Heart Lung and Circulation, vol. 31, no. 7, pp. 1015-1022. https://doi.org/10.1016/j.hlc.2022.01.014

TY - JOUR

T1 - Deep Vein Thrombosis is Common After Cardiac Ablation and Pre-Procedural D-Dimer Could Predict Risk

AU - Bruce, Charo

AU - Saraf, Karan

AU - Rogers, Steven

AU - El-Omar, Magdi

AU - Kirkwood, Graeme

AU - Kelland, Nicholas F

AU - Shah, Dinakshi

AU - Chalil, Shajil

AU - Fullwood, Catherine

AU - Wright, Matthew

AU - Jamil-Copley, Shahnaz

AU - Fox, David

AU - Abozguia, Khalid

AU - Thachil, Jecko

AU - McCollum, Charles

AU - Morris, Gwilym M

N1 - Funding Information: A research grant from of Bristol Myers Squibb , a grant from the British Heart Foundation , and study funding from NIHR . Publisher Copyright: © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

PY - 2022/7/1

Y1 - 2022/7/1

N2 - 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: https://clinicaltrials.gov/ct2/show/NCT03877770.

AB - 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: https://clinicaltrials.gov/ct2/show/NCT03877770.

KW - Biomarker

KW - Catheter ablation

KW - Complication

KW - Supraventricular tachycardia

KW - Thrombosis

U2 - 10.1016/j.hlc.2022.01.014

DO - 10.1016/j.hlc.2022.01.014

M3 - Article

C2 - 35301985

SN - 1443-9506

VL - 31

SP - 1015

EP - 1022

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

IS - 7

ER -