心房颤动射频消融术中经验性抗凝方案评价

Initial evaluation of monitoring activated clotting times during atrial fibrillation ablation

目的观察心房颤动（房颤）射频导管消融术中经验性抗凝活化凝血时间（ACT）达标情况及短期术后血栓并发症发生情况。方法顺序入选2011年我院行射频导管消融治疗的阵发性或持续性房颤患者87例，术中均依据经验肝素抗凝（即首次穿刺房间隔后予负荷量肝素100U／kg，术中每小时追加1000U），术中定时监测ACT，如ACT≥250s即为抗凝达标，ACT≥300s则抗凝效果较好。观察ACT达标情况。随访终点：术后1个月脑卒中及严重出血情况（颅内出血、穿刺口血肿、皮肤黏膜出血）。结果87例患者测定ACT总体达标率为74．1％，未达标25．9％。ACT全程达标患者共45例，达标率为51．7％。术中术后无血栓及出血事件发生。结论虽然房颤消融术中经验性抗凝多数患者可以全程达标抗凝，但仍有部分患者部分时间ACT未达到抗凝标准，存在潜在血栓及出血不良事件发生风险，建议遵循指南进行术中ACT监测指导抗凝。大体重的阵发性房颤患者，术中经验性抗凝不易达标，需要加强抗凝，提高达标率。

Objective To evaluate the efficacy of empirical anticoagulation during AF ablation. Methods Eighty seven consecutive AF patients in our hospital were involved in this study. All patients underwent left atrial irrigated ablation. Based on our experiences, every patient received an intravenous heparin bolus 100 U/kg immediately after the initial transeptal access, followed by additional heparin 1000 U per hour until finishing procedures. In addition,irrigation rate was maintained at a continuous 2 ml/min of heparin saline （1U/ml） during whole procedures while irrigation rate was set at 17-20 ml/min during ablation to protect the catheter from thrombosis. ACT of more than 250 seconds was regarded as effective antieoagulation. Hemorrhagic and thrombotic events during the procedure and 1 month after procedures were evaluated. Results Effective anticoagulation based on empirical administration of heparin was 74. 1%. No thromboembolic or hemorrhagic events were observed. Conclusions Empirical administration of heparin during AF ablation procedure is effective and safe for most patients. But the potential risk of thromboembolic events still exist because of the substandard ACT during the procedure. It＇ s necessary to strengthen the monitoring of anti-coagulations.