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.
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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