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102/Symptomatic venous thromboembolism after catheter ablation

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr102

Background: Catheter ablation is a routine and effective treatment for supraventricular tachycardia (SVT). Femoral venous catheterisation presents an increased risk of venous thromboembolism (VTE). VTE can result in excess patient morbidity and mortality; however, data is limited regarding the incidence of post-procedure VTE in patients undergoing ablation. Current data comes from retrospective database studies. We aimed to systematically study the incidence of symptomatic VTE from a prospective cohort.
Methods: We studied the incidence of patients with symptomatic VTE post-catheter ablation for SVT across two tertiary referral centres.
Patients were identified from the waiting list for electrophysiology study and ablation. Principle inclusion criteria were 18–80 years old, procedure time 1–4 hours, 3–5 vascular sheaths in the femoral vein. Patients were excluded if they had suffered from previous VTE, if no ablation was performed, if peri-procedural anticoagulation was given, if a pacemaker was in situ or if atrial fibrillation/flutter were present. Patients were assessed for signs or symptoms of deep venous thrombosis (DVT) or pulmonary embolism (PE), and consent was gained to access GP notes to review any formal diagnoses since procedure.
Results: Forty patients were available for telephone contact. The overall VTE rate was 2.5%. One patient out of 40 developed a PE with chest pain and breathlessness requiring hospitalisation, however, no patients in the group had developed symptomatic DVT.
Conclusion: Studies have suggested that the incidence of PE has ranged from 0% to 1.67% for non-AF ablation procedures.1 Our review suggests an increased incidence of PE post-procedure compared to this and also to that of the general population of 0.05%.2 However, this is within the limitation of a small sample and a low event rate. No patients developed symptomatic DVT post-procedure. Our primary outcome was to assess patients with symptomatic VTE and this may therefore underestimate the true number of patients who may have asymptomatic disease. A prospective observational study of ultrasound detected VTE post-ablation is required to determine the true incidence of this condition.

References

  1. Burstein B, Barbosa RS, Kalfon E, et al. Venous Thrombosis after electrophysiology procedures: A systematic review. CHEST. 2017;152(3):574–86.
  2. Tagalakis, V., Patenaude, V., Kahn, S. R., Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: The Q-VTE study cohort. Am J Med. 2013;126(9);832.e13–e21.
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