Article ; Online: Thromboembolism prophylaxis practices of pediatric and congenital electrophysiologists during invasive electrophysiology studies: A PACES survey.
Pacing and clinical electrophysiology : PACE
2024 Volume 47, Issue 3, Page(s) 365–372
Abstract: Background: Thromboembolic events related to invasive electrophysiology studies, while rare, can have devastating consequences. Use of systemic anticoagulation for a pediatric or adult-congenital invasive electrophysiology study is recommended, however ... ...
| Abstract | Background: Thromboembolic events related to invasive electrophysiology studies, while rare, can have devastating consequences. Use of systemic anticoagulation for a pediatric or adult-congenital invasive electrophysiology study is recommended, however there is no established standard of practice in this population. Objective: To report on procedural practices for thromboembolism prophylaxis during invasive electrophysiology studies for pediatric patients and adults with congenital heart disease. Methods: An anonymous web-based survey was sent to the members of the Pediatric and Congenital Electrophysiology Society. The survey focused on pre-procedural, intra-procedural, and post-procedural thromboembolism prophylaxis practices during invasive electrophysiology studies. Significant practice variation was defined as <90% concordance among respondents. Results: Survey was completed by 73 members; 52 (71%) practicing in the United States, 65 (89%) practicing in an academic institution, and 14 (19%) in an institution that performs more than 200 invasive electrophysiology procedures annually. Responses showed significant variation in practice. Prior to an invasive electrophysiology procedure, 25% discontinue aspirin while 47% discontinue anticoagulants. Heparin is given for all procedures by 32%. When heparin is administered, the first dose is given by 32% after sheaths are placed, 42% after crossing into the systemic atrium, and 26% just prior to systemic-side ablation. Most target an activated clotting time between 200-300 seconds. Post systemic-side ablation, 58% do not initiate a heparin infusion. Post-procedural oral agents were initiated on day of procedure by 34% of respondents and on post-procedure day 1 by 53%. If treating with aspirin, 74% use low-dose (3-5 mg/kg or 81 mg daily), and 68% treat for 4-6 weeks. Conclusion: There is significant variation in thromboembolism prophylaxis for invasive EP studies among pediatric and congenital electrophysiologists. Further studies are needed to optimize the management of thromboembolism prophylaxis in this population. |
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| MeSH term(s) | Adult ; Humans ; United States ; Child ; Anticoagulants/therapeutic use ; Heparin ; Surveys and Questionnaires ; Thromboembolism/etiology ; Thromboembolism/prevention & control ; Aspirin ; Cardiac Electrophysiology |
| Chemical Substances | Anticoagulants ; Heparin (9005-49-6) ; Aspirin (R16CO5Y76E) |
| Language | English |
| Publishing date | 2024-01-19 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 424437-0 |
| ISSN | 1540-8159 ; 0147-8389 |
| ISSN (online) | 1540-8159 |
| ISSN | 0147-8389 |
| DOI | 10.1111/pace.14928 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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