Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation

Giulio Conte, Carlo de Asmundis, Giannis Baltogiannis, Giacomo Di Giovanni, Giuseppe Ciconte, Juan Sieira, Yukio Saitoh, Kristel Wauters, Giacomo Mugnai, Justo Julià, Ghazala Irfan, Moises Levinstein, Hugo Enrique Cotino-Moreno, Gian Battista Chierchia, Pedro Brugada

Research output: Contribution to journalArticle

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Abstract

Purpose: The aim of this study was to investigate the efficacy and the safety of prophylactic use of protamine in a series of heparinized patients having undergone cryoballoon (CB) ablation for atrial fibrillation (AF).

Methods: From October 2013 to January 2014, 54 consecutive patients received protamine after CB ablation to neutralize unfractionated heparin (UFH) effects. They were prospectively included in this study and compared to a control group of 53 patients who underwent CB ablation without receiving protamine.

Results: A total of 54 consecutive patients (33 male, 61 %; mean age, 58 ± 12 years) were included. Twenty-one patients (39 %) presented with hypertension, 17 (31 %) with dyslipidemia, and 4 (7 %) with diabetes. Five patients (9 %) had a previous episode of ischemic stroke. Mean protamine dose was 68 ± 22 mg. No adverse reaction to protamine was observed. Among patients having received protamine, one (2 %) experienced a cardiac tamponade requiring non-surgical drainage. No patient having undergone protamine administration experienced vascular complications. Conversely, the group of patients not treated with protamine had a significantly higher incidence of vascular complications as compared to patients having undergone protamine infusion (11 vs 0 %, p = 0.01).

Conclusions: Reversing effects of UFH by the means of protamine administration appears to be safe after CB ablation for AF. It can allow in-laboratory sheath removal with potentially less vascular complications and no increase of thromboembolic risk. Larger randomized studies are needed in order to confirm our findings.

Original languageEnglish
Pages (from-to)129-134
Number of pages6
JournalJournal of Interventional Cardiac Electrophysiology
Volume41
Issue number2
DOIs
Publication statusPublished - Oct 8 2014

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Protamines
Atrial Fibrillation
Heparin
Blood Vessels
Cardiac Tamponade
Dyslipidemias
Drainage
Stroke
Hypertension
Safety
Control Groups

Keywords

  • Ablation
  • Atrial fibrillation
  • Cryoballoon
  • Heparin
  • Protamine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation. / Conte, Giulio; de Asmundis, Carlo; Baltogiannis, Giannis; Di Giovanni, Giacomo; Ciconte, Giuseppe; Sieira, Juan; Saitoh, Yukio; Wauters, Kristel; Mugnai, Giacomo; Julià, Justo; Irfan, Ghazala; Levinstein, Moises; Cotino-Moreno, Hugo Enrique; Chierchia, Gian Battista; Brugada, Pedro.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 41, No. 2, 08.10.2014, p. 129-134.

Research output: Contribution to journalArticle

Conte, G, de Asmundis, C, Baltogiannis, G, Di Giovanni, G, Ciconte, G, Sieira, J, Saitoh, Y, Wauters, K, Mugnai, G, Julià, J, Irfan, G, Levinstein, M, Cotino-Moreno, HE, Chierchia, GB & Brugada, P 2014, 'Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation', Journal of Interventional Cardiac Electrophysiology, vol. 41, no. 2, pp. 129-134. https://doi.org/10.1007/s10840-014-9922-y
Conte, Giulio ; de Asmundis, Carlo ; Baltogiannis, Giannis ; Di Giovanni, Giacomo ; Ciconte, Giuseppe ; Sieira, Juan ; Saitoh, Yukio ; Wauters, Kristel ; Mugnai, Giacomo ; Julià, Justo ; Irfan, Ghazala ; Levinstein, Moises ; Cotino-Moreno, Hugo Enrique ; Chierchia, Gian Battista ; Brugada, Pedro. / Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation. In: Journal of Interventional Cardiac Electrophysiology. 2014 ; Vol. 41, No. 2. pp. 129-134.
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abstract = "Purpose: The aim of this study was to investigate the efficacy and the safety of prophylactic use of protamine in a series of heparinized patients having undergone cryoballoon (CB) ablation for atrial fibrillation (AF).Methods: From October 2013 to January 2014, 54 consecutive patients received protamine after CB ablation to neutralize unfractionated heparin (UFH) effects. They were prospectively included in this study and compared to a control group of 53 patients who underwent CB ablation without receiving protamine.Results: A total of 54 consecutive patients (33 male, 61 {\%}; mean age, 58 ± 12 years) were included. Twenty-one patients (39 {\%}) presented with hypertension, 17 (31 {\%}) with dyslipidemia, and 4 (7 {\%}) with diabetes. Five patients (9 {\%}) had a previous episode of ischemic stroke. Mean protamine dose was 68 ± 22 mg. No adverse reaction to protamine was observed. Among patients having received protamine, one (2 {\%}) experienced a cardiac tamponade requiring non-surgical drainage. No patient having undergone protamine administration experienced vascular complications. Conversely, the group of patients not treated with protamine had a significantly higher incidence of vascular complications as compared to patients having undergone protamine infusion (11 vs 0 {\%}, p = 0.01).Conclusions: Reversing effects of UFH by the means of protamine administration appears to be safe after CB ablation for AF. It can allow in-laboratory sheath removal with potentially less vascular complications and no increase of thromboembolic risk. Larger randomized studies are needed in order to confirm our findings.",
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T1 - Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation

AU - Conte, Giulio

AU - de Asmundis, Carlo

AU - Baltogiannis, Giannis

AU - Di Giovanni, Giacomo

AU - Ciconte, Giuseppe

AU - Sieira, Juan

AU - Saitoh, Yukio

AU - Wauters, Kristel

AU - Mugnai, Giacomo

AU - Julià, Justo

AU - Irfan, Ghazala

AU - Levinstein, Moises

AU - Cotino-Moreno, Hugo Enrique

AU - Chierchia, Gian Battista

AU - Brugada, Pedro

PY - 2014/10/8

Y1 - 2014/10/8

N2 - Purpose: The aim of this study was to investigate the efficacy and the safety of prophylactic use of protamine in a series of heparinized patients having undergone cryoballoon (CB) ablation for atrial fibrillation (AF).Methods: From October 2013 to January 2014, 54 consecutive patients received protamine after CB ablation to neutralize unfractionated heparin (UFH) effects. They were prospectively included in this study and compared to a control group of 53 patients who underwent CB ablation without receiving protamine.Results: A total of 54 consecutive patients (33 male, 61 %; mean age, 58 ± 12 years) were included. Twenty-one patients (39 %) presented with hypertension, 17 (31 %) with dyslipidemia, and 4 (7 %) with diabetes. Five patients (9 %) had a previous episode of ischemic stroke. Mean protamine dose was 68 ± 22 mg. No adverse reaction to protamine was observed. Among patients having received protamine, one (2 %) experienced a cardiac tamponade requiring non-surgical drainage. No patient having undergone protamine administration experienced vascular complications. Conversely, the group of patients not treated with protamine had a significantly higher incidence of vascular complications as compared to patients having undergone protamine infusion (11 vs 0 %, p = 0.01).Conclusions: Reversing effects of UFH by the means of protamine administration appears to be safe after CB ablation for AF. It can allow in-laboratory sheath removal with potentially less vascular complications and no increase of thromboembolic risk. Larger randomized studies are needed in order to confirm our findings.

AB - Purpose: The aim of this study was to investigate the efficacy and the safety of prophylactic use of protamine in a series of heparinized patients having undergone cryoballoon (CB) ablation for atrial fibrillation (AF).Methods: From October 2013 to January 2014, 54 consecutive patients received protamine after CB ablation to neutralize unfractionated heparin (UFH) effects. They were prospectively included in this study and compared to a control group of 53 patients who underwent CB ablation without receiving protamine.Results: A total of 54 consecutive patients (33 male, 61 %; mean age, 58 ± 12 years) were included. Twenty-one patients (39 %) presented with hypertension, 17 (31 %) with dyslipidemia, and 4 (7 %) with diabetes. Five patients (9 %) had a previous episode of ischemic stroke. Mean protamine dose was 68 ± 22 mg. No adverse reaction to protamine was observed. Among patients having received protamine, one (2 %) experienced a cardiac tamponade requiring non-surgical drainage. No patient having undergone protamine administration experienced vascular complications. Conversely, the group of patients not treated with protamine had a significantly higher incidence of vascular complications as compared to patients having undergone protamine infusion (11 vs 0 %, p = 0.01).Conclusions: Reversing effects of UFH by the means of protamine administration appears to be safe after CB ablation for AF. It can allow in-laboratory sheath removal with potentially less vascular complications and no increase of thromboembolic risk. Larger randomized studies are needed in order to confirm our findings.

KW - Ablation

KW - Atrial fibrillation

KW - Cryoballoon

KW - Heparin

KW - Protamine

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