Affiliation:
1. Department of Anesthesia and Critical Care Medicine Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
2. Division of Pediatric Cardiology Department of Pediatrics NYU Grossman School of Medicine New York New York USA
Abstract
AbstractBackgroundThromboembolic 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.ObjectiveTo report on procedural practices for thromboembolism prophylaxis during invasive electrophysiology studies for pediatric patients and adults with congenital heart disease.MethodsAn 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.ResultsSurvey 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.ConclusionThere 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.