Chilukuri Karuna, Henrikson Charles A, Dalal Darshan, Scherr Daniel, MacPherson Edwin C, Cheng Alan, Spragg David, Nazarian Saman, Sinha Sunil, Berger Ronald, Marine Joseph E, Calkins Hugh
Department of Medicine, Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
J Interv Card Electrophysiol. 2009 Sep;25(3):175-81. doi: 10.1007/s10840-009-9364-0. Epub 2009 Mar 5.
Aggressive anticoagulation with heparin to maintain an activated clotting time (ACT) >300 s is required during catheter ablation of atrial fibrillation (AF) to reduce the risk of systemic thromboembolism. The purpose of this study is to describe the incidence and outcome of protamine reactions and analyze the risk factors in patients undergoing catheter ablation of AF.
The patient population included 242 consecutive patients (193 men, age 57.6 +/- 10.8 years) with drug refractory AF who underwent catheter ablation and received protamine immediately following catheter ablation to reverse the effects of heparin. Fifty eight of these patients had prior exposure to protamine.
Three of the 242 patients in our study developed an adverse reaction to protamine (1.2%). Although each of the three protamine reaction presented in a dramatic fashion with profound hypotension, all three patients responded to medical treatment and did not experience clinical sequelae. Age, gender, type of AF, number of ablations, prior exposure, diabetes mellitus, and ejection fraction did not predict the occurrence of these reactions.
This study reports, for the first time, the incidence and outcomes of protamine reaction in patients undergoing catheter ablation of AF. The results of this study reveal that protamine reactions present in a dramatic fashion often with profound hypotension. Although the incidence of protamine reactions in this setting is low (1.2%), they do occur. Electrophysiologists who use protamine need to be aware of this reaction and the appropriate therapeutic interventions.
在心房颤动（AF）导管消融过程中，需要积极使用肝素进行抗凝以维持活化凝血时间（ACT）>300秒，以降低全身性血栓栓塞的风险。本研究的目的是描述鱼精蛋白反应的发生率和结局，并分析接受AF导管消融患者的危险因素。
患者群体包括242例连续的药物难治性AF患者（193例男性，年龄57.6±10.8岁），他们接受了导管消融，并在导管消融后立即接受鱼精蛋白以逆转肝素的作用。其中58例患者曾接触过鱼精蛋白。
我们研究中的242例患者中有3例对鱼精蛋白产生不良反应（1.2%）。尽管这三例鱼精蛋白反应均表现为严重低血压的剧烈症状，但所有三名患者均对治疗有反应，且未出现临床后遗症。年龄、性别、AF类型、消融次数、既往接触史、糖尿病和射血分数均不能预测这些反应的发生。
本研究首次报告了接受AF导管消融患者中鱼精蛋白反应的发生率和结局。本研究结果显示，鱼精蛋白反应通常表现为严重低血压的剧烈症状。尽管在这种情况下鱼精蛋白反应的发生率较低（1.2%），但确实会发生。使用鱼精蛋白的电生理学家需要了解这种反应及适当的治疗干预措施。
