Efficacy and Safety of a Nurse-Driven Heparin Protocol During Atrial Fibrillation Ablation

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Authors

• Matthew Hollowell, Corewell Health West Fellow
• Jack Tietema, Michigan State University College of Human Medicine Medical Student
• Jagienka Timek, Michigan State University College of Human Medicine Medical Student
• Joseph Banno, Corewell Health West
• Anastasia Bury, Corewell Health West Resident
• Theresa Pasion, Michigan State University College of Human Medicine Medical Student
• Andre J. Gauri, Corewell Health West
• Sanjay Dandamudi, Corewell Health West
• Nagib Chalfoun, Corewell Health West

Description

Atrial fibrillation (AF) is a common arrhythmia with significant morbidity and mortality, affecting at least 10.5 million people in the U.S. alone . Though pharmacological therapy exists to mitigate symptoms and progression of AF, ablation procedures are considered the mainstay and often definitive treatment for AF . Despite its safety and efficacy, the procedure involves risk of thromboembolic events, namely stroke, fatal bleeding, and cardiac tamponade. Administration of anticoagulants, specifically heparin, during AF ablation is critical to minimize complications. However, there is a lack of consensus regarding how to achieve therapeutic activating clotting times (ACT) amongst published protocols. The objective of the present study is to assess the efficacy and safety of a nurse-driven, ACT-guided heparin protocol in patients undergoing AF ablation.

In this retrospective study from 7/1/2022 and 4/30/2023, patients undergoing AF ablation received weight-adjusted, nurse-administered heparin management targeting an ACT ≥ 350 seconds. Efficacy endpoints included time to target ACT and percentage of ACT values within the therapeutic range. Safety was assessed by the incidence of 30-day stroke, bleeding events, and mortality. The data was then compared across different BMI categories (< 25 kg/m2, 25-30 kg/m2, BMI >30 kg/m2) to assess consistency in outcomes and identify potential variations in efficacy and safety.

Of the 476 patients who underwent AF ablation, 336 achieved a therapeutic ACT following an initial heparin loading dose, with a mean time of 18 minutes to reach the target. Thirty-day stroke incidence was low (0.4%), and major bleeding occurred in 0.2% of patients. Minor bleeding events and rehospitalizations were observed in 3.3% and 4.8% of patients respectively.

The nurse-driven, ACT-guided heparin protocol efficiently and safely achieved therapeutic ACT values with minimal adverse effects. Moreover, the success of our protocol and achievement of therapeutic ACT values did not necessitate adjustments to preexisting DOAC use. These findings support an objective, streamlined, and standardized approach to anticoagulation during AF ablation with minimal physician guidance.

Publication Date

5-8-2026

Disciplines

Cardiology

Recommended Citation

Hollowell M, Tietema J, Timek J, Banno J, Bury A, Pasion T, Gauri, A. Dundamudi S, Dahu M, Chalfoun N. Efficacy and safety of a nurse-driven heparin protocol during atrial fibrillation ablation. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1970