Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Yasar, Senan; Bickel, Trent; Zhang, Shiyang; Akkaya, Mehmet; Aznaurov, Sam G.; Krishnan, K. Ranga Rama; Cuculich, Phillip S.; Gautam, Sandeep

doi:10.1111/jce.14253

Cited by 5 publications

(6 citation statements)

References 33 publications

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“…A total of 5 eligible studies (3 retrospective cohort studies and two randomized trials) consisting of 1012 patients (515 patients received protamine group and 497 patients did not receive protamine group) were included in the meta-analysis [2][3][4][5][6]. Overall, the mean age was 62.9 ± 15.6 years, the mean left ventricular ejection fraction was 64.1 ± 5.9%, and 56.8% (n = 575) patients were men.…”

Section: Resultsmentioning

confidence: 99%

“…About 67.9% (n = 687) patients had paroxysmal AF, 31% (n = 314) persistent AF, and 1.1% (n = 11) were unknown AF duration. Pre-ablation anticoagulation strategies differed amongst studies-from uninterrupted warfarin or minimally interrupted direct oral anticoagulants [4,6] to discontinuing oral anticoagulants or warfarin at least 48 hours before and bridging with low molecular weight heparin if indicated [3,5]. 54.25% (n = 549) patients underwent cryoablation, while 45.75% (n = 463) underwent radiofrequency ablation.…”

Section: Resultsmentioning

confidence: 99%

“…Manual compression and bed rest protocol was implemented in both groups in all studies (Table 1 (Ref. [2][3][4][5][6]) highlights the details on post-procedure management). The two groups were well balanced with respect to baseline demographics and clinical characteristics (p-value > 0.05 for all).…”

Section: Resultsmentioning

confidence: 99%

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Periprocedural outcomes of protamine administration after catheter ablation of atrial fibrillation

Kewcharoen¹,

Shah²,

Bhardwaj³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Perioperative anticoagulation management with uninterrupted or minimally interrupted anticoagulation during atrial fibrillation (AF) ablation is thought to be critical to minimize thromboembolic complications. Protamine is often administered to neutralize the effects of heparin and expedite vascular hemostasis post-procedure. Objective: We performed a systematic review and meta-analysis to determine the effectiveness of protamine to expedite vascular hemostasis and ambulation in patients undergoing AF ablation. Methods: Electronic searches on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from the inception through August 7, 2021, were performed. The primary outcomes included-time to hemostasis (minutes) and time to ambulation (minutes). The secondary outcomes included -any vascular complications (excluding minor hematoma), minor hematoma, or cerebrovascular accidents (CVA). Results: A total of 5 eligible studies (3 retrospective cohort studies and two randomized trials) consisting of 1012 patients (515 patients received protamine group and 497 patients did not receive protamine group) were included in the meta-analysis. There was a significant reduction in time to ambulation [weighted mean difference (WMD) -176.6 minutes, 95% Confidence interval (CI) -266.9 to -86.3; p < 0.01] and time to hemostasis (WMD -13.72 minutes, 95% CI -22 to -5.4, p < 0.01) in the protamine group compared to the contrary. At a follow-up up to 3 months, there was no statistical difference between the two groups with regards to vascular complications (2.9% vs. 7.4%; Risk ratio (RR) 0.46 95% CI 0.17 to 1.24; p = 0.12), minor hematoma (2.1% vs. 5.8%; RR 0.43, 95% CI 0.16 to 1.2; p = 0.11) or CVA (0 vs. 0.3%; RR 0.62, 95% CI 0.08 to 4.98; p = 0.65). Conclusion: Protamine administration was associated with reduced time to ambulation (176 minutes reduction) and time to hemostasis (13 minutes reduction) without an increase in any adverse events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Periprocedural outcomes of protamine administration after catheter ablation of atrial fibrillation

Kewcharoen¹,

Shah²,

Bhardwaj³

et al. 2022

Rev. Cardiovasc. Med.

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“…При необходимост от комбиниране на венозна изолация с линейни лезии вместо циркулярния мепинг катетър се използва 16-полюсен (4 х 4) катетър за високоплътностен мепинг Advisor HD Grid (Abbott, USA). В края на процедурата системният хепаринов ефект не се неутрализира с протамин, а вместо това се прилага временен хемостазен Z-шев, затегнат с трипътно кранче или възел, което позволява незабавно отстраняване на интродюсерите без мануална компресия и максимално бързо раздвижване на пациента [16,17].…”

Section: Classifi Cation and Defi Nitions Of Anatomical Variants Of Pulmonary Venous Drainage In The Launclassified

“…If it is necessary to combine pulmonary vein isolation with linear lesions, a 16-pole (4x4) high-density mapping catheter Advisor HD Grid (Abbott, USA) is used instead of the circular mapping catheter. At the end of the procedure, the systemic heparin eff ect is not reversed with protamine; instead, a temporary hemostatic Z-suture is applied and tightened with a three-way stopcock or knot, which allows immediate removal of the introducers without manual compression and maximally rapid ambulation of the patient [16,17].…”

mentioning

confidence: 99%

Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

Динева¹,

Стоянов²,

Партенова³

et al. 2021

Bulgarian Cardiology

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Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial ﬁ brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signiﬁ cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after ﬁ rst pulmonary vein isolation.

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Safety of multi-access site venous closure following catheter ablation of atrial fibrillation and flutter

Gupta,

Kolluri,

Simoes

et al. 2024

J Interv Card Electrophysiol

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Background Following catheter ablation, vascular access management involves potential complications and prolonged recovery. Recently, suture-mediated closure (SMC) devices were approved for venous access procedures. The objective of this study is to evaluate the safety of a commercially available SMC for multiple access site venous closure by duplex ultrasound (DUS) in asymptomatic subjects with non-visible complications. Methods Thirty-six subjects (63 ± 10.7 years old, 12 female) were enrolled. Following catheter ablation for atrial fibrillation, all subjects had SMC of every venous access site. Subjects underwent DUS of femoral veins and arteries. DUS was performed at discharge, and again at 30 days. Subjects were evaluated for clinically apparent vascular complications. Results Mean procedure duration was 138.6 min, and the time to hemostasis was 3.1 min/access site and 9.5 min/subject. Median time to ambulation was 193.5 min, and median time to discharge was 5.95 h, with discharge as early as 2.4 h. A median of 2 sheaths/vein and a median of 2 SMC devices/vein were used. There were no major complications and a 16.7% (6/36) minor complication rate at discharge. All complications resolved at 30 days. The complication rate was not higher in patients with 2 SMC per access site as compared to the patients who just received 1 SMC per access site. Conclusions This study demonstrates the safety of multi-access closure using SMC, following catheter ablation procedures, for closure of sites that use sheath sizes from ≤ 8F to ≥ 15F and for those that use 2 or more SMCs per access site. Graphical abstract

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Heparin reversal with protamine sulfate is not required in atrial fibrillation ablation with suture hemostasis

Cited by 5 publications

References 33 publications

Periprocedural outcomes of protamine administration after catheter ablation of atrial fibrillation

Periprocedural outcomes of protamine administration after catheter ablation of atrial fibrillation

Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

Safety of multi-access site venous closure following catheter ablation of atrial fibrillation and flutter

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