INTRODUCTION
Arrhythmia treatment via left atrial ablation procedures is associated with peri-procedural risk of thromboembolism at a reported rate of 0-7%.1 To mitigate this risk, meticulous peri-procedural practices should be employed including pre-procedural imaging to rule out left atrial thrombus, vigilant sheath management, careful control of radiofrequency (RF) energy, and a strict peri-procedural anticoagulation strategy. Prior studies have demonstrated that thrombi can form on sheaths or catheters almost immediately after transseptal puncture, and peri-procedural anticoagulation via intravenous heparin can reduce this risk.2,3A therapeutic Activated Clotting Time (ACT) goal of > 300 seconds should be targeted, as this value has been associated with reduced thromboembolic complications, without increased bleeding complications.4,5
Contemporary anticoagulation practices during left atrial catheter ablation procedures can vary among operators, particularly in regard to the effect of patient size and peri-procedural oral anticoagulation. To reduce the likelihood of sub-therapeutic heparin dosing, a weight-based heparin dosing policy which adjusted for pre-procedural oral anticoagulation was implemented. We performed an observational quality improvement study to evaluate whether an implemented protocol would result in altered dosing practices, a greater prevalence of therapeutic ACT values, and a decrease in time to therapeutic ACT during left atrial ablation procedures compared to a retrospective cohort of similar patients.