Femoral vascular complications following catheter ablation of atrial fibrillation

Femoral vascular complications remain a significant complication of catheter ablation of atrial fibrillation as a result of peri-procedural anticoagulation protocols. We investigated the effect of three different anti-coagulation regimens on the incidence of femoral vascular complications following AF ablation over a 4 year period. We performed 603 catheter ablations in 539 patients from January 2004 to January 2008. All patients were started on coumadin immediately after procedure and received enoxaparin at 1 mg/kg 4 h post procedure and again 12 h later. Three protocols for enoxaparin, administered 12 hourly, were used post-procedure: Protocol A-1 mg/kg x ten doses; Protocol B-1 mg/kg x six doses, and Protocol C-0.5 mg/kg x six doses. We documented occurrence of femoral vascular complications prior to discharge and at the 1 month post-op visit using a prospective database. A femoral vascular complication was defined as hematoma requiring prolonged hospitalization, blood transfusion or surgical intervention. There were 21 femoral vascular complications during the study period. The rate of complication fell from 5.7% (protocol A) to 1.6% (protocol C) (p < 0.03). We attribute the decrease in complication rate to the shorter anticoagulation protocol, as the reduction remained significant regardless of variation in catheter sizes. There were no new cerebral vascular events with the lower enoxaparin protocols. A shorter course of post procedure anticoagulation protocol can reduce femoral complications without contributing to increased risk of thromboembolic events.