title: Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation.
abstract: OBJECTIVE
  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.
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium, giulioconte.cardio@gmail.com.
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.forename: Giannis
authors.initials: G
authors.lastname: Baltogiannis
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Giovanni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.forename: Juan
authors.initials: J
authors.lastname: Sieira
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.forename: Kristel
authors.initials: K
authors.lastname: Wauters
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.forename: Justo
authors.initials: J
authors.lastname: Julià
authors.forename: Ghazala
authors.initials: G
authors.lastname: Irfan
authors.forename: Moises
authors.initials: M
authors.lastname: Levinstein
authors.forename: Hugo Enrique
authors.initials: HE
authors.lastname: Cotino-Moreno
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006494:Heparin Antagonists / Q000008:administration & dosage*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage*; D018709:Statistics, Nonparametric; D013927:Thrombosis / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006494:Heparin Antagonists; D011479:Protamines; D006493:Heparin