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

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.