Pediatric Cardiology

, Volume 39, Issue 5, pp 941–947 | Cite as

Development and Implementation of a Standardized Heparin Protocol for Left-Sided Pediatric Electrophysiology Procedures

  • Emily F. Moore
  • Jennifer Pak
  • Christa Jefferis-Kirk
  • Arlene Armatage
  • Richard A. Kronmal
  • Jack C. Salerno
  • Matthew D. Files
Original Article


Heparin is used to decrease the risk of thromboembolic complications during electrophysiology studies (EPS); however, there is wide practice variation and minimal evidence to guide heparin dosing, particularly in pediatric patients. This study retrospectively analyzed heparin dosing and response, measured via activated clotting time (ACT), in patients undergoing EPS and used these data (pre-protocol cohort, n = 40), as well as guidance from available literature to implement a standardized heparin protocol (phase 1, n = 43). We utilized quality improvement methodology to refine this protocol (phase 2, n = 40) to improve therapeutic heparin response. Prior to the protocol, patients achieved therapeutic ACT levels (250–350 s) only 35% of the time which improved to 60% during phase 1 (p < 0.05) and to 73% during phase 2 (p < 0.001 compared to pre-protocol). There were no thromboses or significant adverse events in any group. These results demonstrate the effectiveness of a standardized heparin protocol in achieving effective antithrombotic therapy during left-sided pediatric EPS.


Arrhythmia Electrophysiological procedures Heparin Anticoagulation Pediatric cardiology Children Radiofrequency ablation Catheter ablation 


Compliance with Ethical Standards

Conflict of interest

None of the authors have a conflict of interest or relevant relationship with industry.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Seattle Children’s Hospital IRB approved the human research conducted in this study. Formal consent was not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Emily F. Moore
    • 1
  • Jennifer Pak
    • 2
  • Christa Jefferis-Kirk
    • 2
  • Arlene Armatage
    • 1
  • Richard A. Kronmal
    • 3
  • Jack C. Salerno
    • 4
  • Matthew D. Files
    • 4
  1. 1.Division of Cardiology and Cardiac SurgeryHeart Center at Seattle Children’s HospitalSeattleUSA
  2. 2.Department of PharmacySeattle Children’s HospitalSeattleUSA
  3. 3.Department of Biostatistics, Collaborative Health Studies Coordinating CenterUniversity of WashingtonSeattleUSA
  4. 4.Division of Pediatric Cardiology, Department of PediatricsUniversity of WashingtonSeattleUSA

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