Implementation of a Standardized Nurse‐Guided Heparinization Protocol Improves Anticoagulation During Left Atrial Ablation Procedures

Abstract

BACKGROUND AND AIMS: Effective intraprocedural anticoagulation is essential during catheter ablation of atrial fibrillation (AF) and left atrial tachycardia (AT) procedures. This study evaluated a novel, standardized, nurse-led heparin protocol regarding anticoagulation performance and safety. METHODS: Consecutive patients undergoing AF or AT ablation between May 2022 and 2023 were treated using a standardized heparinization protocol managed by electrophysiology nursing staff (study group) and compared with consecutive patients undergoing ablation between May 2021 and April 2022, in whom heparin was administered at the operator's discretion (control group). Patients in the study cohort received an initial dose of 5000 IU heparin after venous access and a supplemental bolus (1000 IU/10 kg above 50 kg bodyweight) after transseptal puncture. ACT was then assessed every 20 min using a point-of-care coagulation device in both groups. Repeat heparin administration was autonomously performed by nurses in the study group following a standardized protocol. The primary endpoint was the proportion of patients in whom at least one intraprocedural ACT measurement exceeded 300 s at any time during the procedure. RESULTS: Each group included 655 patients with comparable baseline characteristics. The study group more frequently achieved the therapeutic target (ACT > 300 s, 84.6% vs. 59.7%, p < 0.0001), reached therapeutic ACT faster, and showed fewer exclusively subtherapeutic ACT values. Excessive anticoagulation was less common (ACT > 400 s: 2.0% in the study group vs. 5.0% in the control group, p = 0.0027). Complication rates were low and similar in both groups. CONCLUSIONS: A standardized, nurse-led heparinization protocol improved the speed, consistency, and precision of intraprocedural anticoagulation during left atrial ablation without increasing procedural complications.