Evaluation of an adaptive, rule-based dosing algorithm to maintain therapeutic anticoagulation during atrial fibrillation ablation

Cerebral thromboembolism during atrial fibrillation (AF) ablation is an infrequent (0.17%) complication in part owing to strict adherence to intraprocedural anticoagulation. Failure to maintain therapeutic anticoagulation can lead to an increase in events, including silent cerebral ischemia. To eval...

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Bibliographic Details
Published in:	Cardiovascular digital health journal Vol. 4; no. 6; pp. 173 - 182
Main Authors:	Kalscheur, Matthew M, Martini, Matthew R, Mahnke, Marcus, Osman, Fauzia, Modaff, Daniel S, Fleeman, Blake E, Kipp, Ryan T, Wright, Jennifer M, Medow, Joshua E
Format:	Journal Article
Language:	English
Published:	United States Elsevier 01-12-2023
Subjects:	Original Clinical decision support system Quality improvement Anticoagulation Atrial fibrillation Catheter ablation Implementation
Online Access:	Get full text
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Summary:	Cerebral thromboembolism during atrial fibrillation (AF) ablation is an infrequent (0.17%) complication in part owing to strict adherence to intraprocedural anticoagulation. Failure to maintain therapeutic anticoagulation can lead to an increase in events, including silent cerebral ischemia. To evaluate a computerized, clinical decision support system (CDSS) to dose intraprocedural anticoagulation and determine if it leads to improved intraprocedural anticoagulation outcomes during AF ablation. The Digital Intern dosing algorithm is an adaptive, rule-based CDSS for heparin dosing. The initial dose is calculated from the patient's weight, baseline activated clotting time (ACT), and outpatient anticoagulant. Subsequent recommendations adapt based on individual patient ACT changes. Outcomes from 50 cases prior to algorithm introduction were compared to 139 cases using the algorithm. Procedures using the dosing algorithm reached goal ACT (over 300 seconds) faster (17.6 ± 11.1 minutes vs 33.3 ± 23.6 minutes pre-algorithm, < .001). ACTs fell below goal while in the LA (odds ratio 0.20 [0.10-0.39], < .001) and rose above 400 seconds less frequently (odds ratio 0.21 [0.07-0.59], = .003). System Usability Scale scores were excellent (96 ± 5, n = 7, score >80.3 excellent). Preprocedure anticoagulant, weight, baseline ACT, age, sex, and renal function were potential predictors of heparin dose to achieve ACT >300 seconds and final infusion rate. A heparin dosing CDSS based on rules and adaptation to individual patient response improved maintenance of therapeutic ACT during AF ablation and was rated highly by nurses for usability.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2666-6936 2666-6936
DOI:	10.1016/j.cvdhj.2023.11.001