Background: Radiofrequency ablation (RFA) in the left heart is associated with thromboembolic complications. Thrombus formation on the transseptal sheaths and at the ablation sites has been reported.
Methods: All prospectively evaluated patients were prescribed ASA 81mg for 3 days before RFA and for the following 6 – 8 weeks. A 100 units/kg heparin bolus was given as the first flush through the transseptal sheath followed by continuous heparin infusion 20 units/kg (maximum 1000 units/kg). All patients were scheduled for transthoracic echocardiograms on day 1 and 2 - 3 weeks later.
Results: Between March 2006 and December 2008, 67 patients (28 female), age 0.8 - 17 years (mean 12.2 years) underwent RFA. All patients had accessory pathways except for 3 patients with ectopic atrial tachycardia. A single patient had mild Ebstein’s anomaly of the tricuspid valve. Transseptal puncture was done in 49 patients (43 with TEE guidance). Eighteen patients had a PFO. The LA catheter time was 10 – 120 min (mean 38 min). The RF application time was 30 – 794 sec (mean 210 sec). The ACT was 165 – 377 sec (mean 254 sec). The permanent RFA success rate was 88%. No patient developed thromboembolic complications. No patient had a recognizable thrombus by echo on day 1 (4 patients had small pericardial fluid) and none of 56 patients on follow up, mean 17 days post RFA. One patient had new mild/moderate mitral regurgitation.
Conclusion: Thorough anticoagulation with heparin combined with administration of low dose ASA may prevent thrombotic complications.