Activated clotting time for anticoagulation management during left-atrial catheter ablation: an international survey of current strategies
B Kovacs, L Dinshaw, D Schoeppenthau, V Spahiu, A Briosa E Gala, A Marco Del Castillo, S Kurath-Koller, S Stojkovic, S Simovic, I Zeljkovic, D Linz, L Roten, B Vandenberk, K Vernooy, T ReichlinAbstract
Introduction
Intraprocedural anticoagulation with unfractionated heparin is a standard in left-sided ablation to prevent periprocedural stroke. However, activated clotting time (ACT) targets and point-of-care methodology lack standardization. Currently three main kaolin-based ACT measurement methods are used (optical, electromechanical and electrochemical). We aimed to assess the current status of ACT targets and measurement devices used and heparin dosing practices across contemporary clinical EP practice.
Methods
An international web-based survey was performed among practicing electrophysiologists. Seventeen questions about heparin administration timing and dosing, ACT target range for standard left-sided procedures, ACT measurement device used, and whether a recent change in ACT device led to an adjustment in heparin dosing practice were asked. For analytic purposes, the most commonly used device families will be called "Optical", "Electromechanical " and "Electrochemical". Descriptive statistics are reported here.
Results
The survey was completed by158 respondents, 130 (82%) from Europe, 19 (12%) North America and 9 (6%) from other regions. Target heparin dose administered was ≥150 IU/kg, 100-149 IU/kg or ≤100 IU/kg and variable by 45 (28%), 90 (57%), 6 (4%) and 14 (9%, with 3, 2% not reported) (Figure 1). Heparin was administered after vascular access (100, 63%) or transseptal puncture (52, 33%) or in split doses (6, 4%). The therapeutic ACT goal was ≥350 sec, 300-349 sec, 250-299 sec and 200-249 sec in 35 (22%), 101 (64%), 19 (12%) and 3 (2%), respectively). In total of 11 different types of ACT devices were used. Most platforms employed optical clot-detection technology (n=63; 40%), followed by electromechanical and electrochemical methods (37, 23% and 26, 17%, respectively). ACT targets were heterogeneous across devices (Figure 2). Forty-eight (30%) respondents changed ACT systems/cartridges in the prior 5 years. Of these, 31 adjusted their heparin dosing (13 increased by ≥5’000 IU, 15 changed by ±5’000 IU and 3 decreased by <5’000 IU .
Conclusions
There is a substantial heterogeneity in current real-world ACT practices, with considerable variation in heparin administration strategies, ACT measurement devices and target ACT ranges during electrophysiology procedures. switching between ACT-platforms frequently resulted in changes in heparin dosing regimes. Further research is needed to compare the performance of different ACT devices and to establish cross-platform comparability.Figure 1:N=158Figure 2:N=158