Arrhythmias & electrophysiology
Activated clotting time platforms matter: Evidence gaps and real-world variability in anticoagulation targets during left atrial ablation
Authors' conclusion
Available cross-validation data indicate substantial differences among ACT platforms. Real-world heparin administration strategies and ACT targets vary markedly by platform. These findings challenge the assumption of universal ACT targets and highlight the need for platform-specific interpretation.
Study context
- Population
- Studies directly comparing activated clotting time (ACT) values across different measurement platforms during left atrial ablation; electrophysiologistselectrophysiologists completing the survey, systematic review identified 4 electrophysiology-specific studies
- Participants
- 164 participants
- Comparison
- ACT values across different measurement platforms during left atrial ablation
- Outcome
- Simultaneously measured ACT values across platforms
Methodological detailsinternational physician survey
- International physician survey
Pooled result
As reported in the abstract
Mean paired differences
50-60 seconds
Discrepancy at ACT targets of 300-350 seconds
15%-25%
Further pooled results
Most used ACT platforms
Survey respondents by region
- From Europe
- 82%
- From North America
- 13%
Target ACT ranges and heparin dosing strategies by platform
- Higher ACT targets and higher weight-based heparin doses were most frequently reported with Hemochron
- Lower targets and doses were more common with i-STAT
- Users of Medtronic showed an intermediate pattern
- Nearly one-third of respondents reported modifying heparin dosing after switching ACT platforms
Original publication
Activated clotting time platforms matter: Evidence gaps and real-world variability in anticoagulation targets during left atrial ablation. Heart Rhythm. Published 7 March 2026. doi:10.
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