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Koshikawa M, Harada M, Nomura Y, Nishimura A, Motoike Y, Watanabe E, Ozaki Y, Izawa H. Impact of different energy sources on coagulation biomarkers and silent cerebral events in balloon-based ablation for atrial fibrillation. Heart Rhythm O2 2024; 5:520-528. [PMID: 39263611 PMCID: PMC11385400 DOI: 10.1016/j.hroo.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Background Different energy sources of balloon-based ablation for pulmonary vein isolation cause different kinds of endothelial damage and coagulation responses associated with thromboembolic risk. Objectives The study sought to compare the impact of different balloon-based ablation, cryoballoon ablation (CBA) and laser balloon ablation (LBA), on coagulation/fibrinolysis biomarkers and silent cerebral events (SCEs) in paroxysmal atrial fibrillation. Methods Paroxysmal atrial fibrillation patients who underwent pulmonary vein isolation using either CBA (n = 52) or LBA (n = 53) without radiofrequency touch-up ablation were eligible. Time course (day 0 [before ablation], day 1, day 2, and day 28) of myocardial enzymes and inflammatory and coagulation/fibrinolysis biomarkers was evaluated during the perioperative period. Brain magnetic resonance imaging was performed within 2 days after the procedure to evaluate SCEs. Results There was no difference in patient characteristics between CBA and LBA.CBA had greater myocardial injury (troponin I and creatine kinase-MB) and lower inflammatory reaction (white blood cell count and neutrophil/lymphocyte ratio) than LBA. The coagulation biomarkers maximally increased by day 2 and then decreased in both groups. In day 28, the serum prothrombin fragment 1+2 and D-dimer levels in LBA were significantly higher than the values in CBA. The fibrinolysis biomarker (plasmin-α2 plasmin inhibitor complex) did not increase after the procedure in either group. The incidence of SCEs was comparable between CBA and LBA (11% vs 15%; P = .591). No thromboembolic event was observed. Conclusion CBA and LBA had different effects on myocardial injury, inflammatory reaction, and coagulation activity but did not affect the incidence of thromboembolic events. LBA had significantly higher coagulation activity in day 28 and may require more careful postprocedural anticoagulation than CBA.
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Affiliation(s)
| | - Masahide Harada
- Department of Cardiology, Fujita Health University, Toyoake, Japan
| | - Yoshihiro Nomura
- Department of Cardiology, Fujita Health University, Toyoake, Japan
| | - Asuka Nishimura
- Department of Cardiology, Fujita Health University, Toyoake, Japan
| | - Yuji Motoike
- Department of Cardiology, Fujita Health University, Toyoake, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan
| | - Yukio Ozaki
- Department of Cardiology, Okazaki Medical Center, Fujita Health University, Okazaki, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Toyoake, Japan
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Popa MA, Hessling G, Deisenhofer I. Reply: Optimal procedural selection for atrial fibrillation catheter ablation to minimize myocardial injury and inflammatory reaction. J Cardiovasc Electrophysiol 2024; 35:868-869. [PMID: 38433305 DOI: 10.1111/jce.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Miruna A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Zakynthinos GE, Tsolaki V, Oikonomou E, Pantelidis P, Gialamas I, Kalogeras K, Zakynthinos E, Vavuranakis M, Siasos G. Unveiling the Role of Endothelial Dysfunction: A Possible Key to Enhancing Catheter Ablation Success in Atrial Fibrillation. Int J Mol Sci 2024; 25:2317. [PMID: 38396990 PMCID: PMC10889579 DOI: 10.3390/ijms25042317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Atrial fibrillation, a prevalent type of arrhythmia, is increasingly contributing to the economic burden on healthcare systems. The development of innovative treatments, notably catheter ablation, has demonstrated both impressive and promising outcomes. However, these treatments have not yet fully replaced pharmaceutical approaches, primarily due to the relatively high incidence of atrial fibrillation recurrence post-procedure. Recent insights into endothelial dysfunction have shed light on its role in both the onset and progression of atrial fibrillation. This emerging understanding suggests that endothelial function might significantly influence the effectiveness of catheter ablation. Consequently, a deeper exploration into endothelial dynamics could potentially elevate the status of catheter ablation, positioning it as a primary treatment option for atrial fibrillation.
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Panteleimon Pantelidis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Ioannis Gialamas
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Mezourlo, 41335 Larissa, Greece; (V.T.); (E.Z.)
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.O.); (P.P.); (I.G.); (K.K.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Popa MA, Bahlke F, Kottmaier M, Foerschner L, Bourier F, Lengauer S, Telishevska M, Krafft H, Englert F, Reents T, Lennerz C, Caluori G, Jaïs P, Hessling G, Deisenhofer I. Myocardial injury and inflammation following pulsed-field ablation and very high-power short-duration ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:317-327. [PMID: 38105426 DOI: 10.1111/jce.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is an established treatment strategy for atrial fibrillation (AF). To improve PVI efficacy and safety, high-power short-duration (HPSD) ablation and pulsed-field ablation (PFA) were recently introduced into clinical practice. This study aimed to determine the extent of myocardial injury and systemic inflammation following PFA, HPSD, and standard RFA using established biomarkers. METHODS We included 179 patients with paroxysmal AF receiving first-time PVI with different ablation technologies: standard RFA (30-40 W/20-30 s, n = 52), power-controlled HPSD (70 W/5-7 s, n = 60), temperature-controlled HPSD (90 W/4 s, n = 32), and PFA (biphasic, bipolar waveform, n = 35). High-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), CK MB isoform (CK-MB), and white blood cell (WBC) count were determined before and after ablation. RESULTS Baseline characteristics were well-balanced between groups (age 63.1 ± 10.3 years, 61.5% male). Postablation hs-cTnT release was significantly higher with PFA (1469.3 ± 495.0 ng/L), HPSD-70W (1322.3 ± 510.6 ng/L), and HPSD-90W (1441.2 ± 409.9 ng/L) than with standard RFA (1045.9 ± 369.7 ng/L; p < .001). CK and CK-MB release was increased with PFA by 3.4-fold and 5.8-fold, respectively, as compared to standard RFA (p < .001). PFA was associated with the lowest elevation in WBC (Δ1.5 ± 1.5 × 109 /L), as compared to standard RFA (Δ3.8 ± 2.5 × 109 /L, p < .001), HPSD-70W (Δ2.7 ± 1.7 × 109 /L, p = .037), and HPSD-90W (Δ3.6 ± 2.5 × 109 /L, p < .001). CONCLUSION Among the four investigated ablation technologies, PFA was associated with the highest myocardial injury and the lowest inflammatory reaction.
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Affiliation(s)
- Miruna A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Leonie Foerschner
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Guido Caluori
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
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Li X, Zhou W, Guo D, Hu Y, Zhou H, Chen Y. Cardiac Radiofrequency Ablation Exacerbates Myocardial Injury through Pro-Inflammatory Response and Pro-Oxidative Stress in Elderly Patients with Persistent Atrial Fibrillation. Curr Vasc Pharmacol 2024; 22:137-152. [PMID: 38213173 DOI: 10.2174/0115701611257644231215071611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/18/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There is a need to assess myocardial damage after radiofrequency ablation of the pulmonary veins (PV) for persistent atrial fibrillation (PAF) in elderly patients. OBJECTIVE To evaluate oxidative stress, inflammatory response and myocardial damage in elderly patients with PAF after radiofrequency ablation of the PV. METHODS High-sensitivity troponin T (hsTnT), malondialdehyde-modified low-density lipoprotein (MDA-LDL), acrolein (ACR), lipid hydroperoxide (LHP), toll-like receptor 4 (TLR4), soluble growth stimulation expressed gene 2 (sST2), angiotensin II (Ang II) and myocardial blood flow (MBF) were determined before ablation and at 1, 3 and 5 months after radiofrequency ablation. RESULTS The levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2 and Ang II were increased 3 months after ablations compared with before ablation and 1 month after ablation, respectively (P<0.001); they were further increased at 5 months after ablation compared with the 1- and 3-month groups, respectively (P<0.001). MBF was decreased in the 3 months group after ablations compared with before ablation and 1-month after ablation, respectively (P<0.001), and was further decreased in 5-months after ablations compared with 1-month and 3-month groups, respectively (P<0.001). Patients with epicardial monopolar radiofrequency ablation had higher levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2, Ang II and lower MBF than patients with endocardial monopolar and bipolar radiofrequency ablations, respectively (P<0.001). CONCLUSION Monopolar radiofrequency ablation method could result in more myocardial injury than bipolar radiofrequency ablation. Oxidative stress and inflammatory response may be involved in cardiac radiofrequency ablation-induced myocardial injury, resulting in myocardial ischemia in elderly patients with PAF.
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Affiliation(s)
- Xia Li
- Xiamen Road Branch Hospital, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 22305, China
| | - Wenhang Zhou
- Xiamen Road Branch Hospital, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 22305, China
| | - Dianxuan Guo
- Xiamen Road Branch Hospital, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 22305, China
| | - Youdong Hu
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Hualan Zhou
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
| | - Ying Chen
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian 223002, China
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Curcio A, Anselmino M, Di Biase L, Migliore F, Nigro G, Rapacciuolo A, Sergi D, Tomasi L, Pedrinelli R, Mercuro G, Filardi PP, Indolfi C. The gray areas of oral anticoagulation for prevention of thromboembolic events in atrial fibrillation patients. J Cardiovasc Med (Hagerstown) 2023; 24:e97-e105. [PMID: 37186560 DOI: 10.2459/jcm.0000000000001461] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Thromboembolic events (TEE) associated with atrial fibrillation (AF) are highly recurrent and usually severe, causing permanent disability or, even, death. Previous data consistently showed significantly lower TEE in anticoagulated patients. While warfarin, a vitamin K antagonist, is still used worldwide, direct-acting oral anticoagulants (DOACs) have shown noninferiority to warfarin in the prevention of TEE, and represent, to date, the preferred treatment. DOACs present favorable pharmacokinetic, safety and efficacy profiles, especially among vulnerable patients including the elderly, those with renal dysfunction or previous TEE. Yet, regarding specific settings of AF patients it is unclear whether oral anticoagulation therapy is beneficial, or otherwise it is the maintenance of sinus rhythm, mostly achieved through a catheter ablation-based rhythm control strategy, that prevents the causal complications linked to AF. While it is known that low-risk patients [CHA2DS2-VASc 0 (males), or score of 1 (females)] present low ischemic stroke or mortality rates (<1%/year), it remains unclear whether they need any prophylaxis. Furthermore, the appropriate anticoagulation regimen for those individuals requiring cardioversion, either pharmacologic or electric, as well as peri-procedural anticoagulation in patients undergoing trans-catheter ablation that nowadays encompasses different energies, are still a matter of debate. In addition, AF concomitant with other clinical conditions is discussed and, lastly, the choice of prescribing anticoagulation to asymptomatic patients diagnosed with subclinical AF at either wearable or implanted devices. The aim of this review will be to provide an update on current strategies in the above-mentioned settings, and to suggest possible therapeutic options, finally focusing on AF-related cognitive decline.
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Affiliation(s)
- Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University
| | - Matteo Anselmino
- Division of Cardiology, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Italy
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, New York, USA
| | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova
| | - Gerardo Nigro
- Università della Campania Luigi Vanvitelli (Second University of Naples)
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples
| | - Domenico Sergi
- Unit of Cardiology, Department of Systems Medicine, University of Rome Tor Vergata, Rome
| | - Luca Tomasi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Verona, Verona
| | - Roberto Pedrinelli
- Department of Surgical, Clinical and Molecular Pathology and Intensive Care, University of Pisa, Pisa
| | - Giuseppe Mercuro
- Department of Internal Sciences and Public Health, University of Cagliari, Cagliari
| | | | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University
- Mediterranea Cardiocentro, Naples, Italy
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Kassa KI, Nagy Z, Simkovits D, Kis Z, Ferenci T, Som Z, Foldesi C, Kardos A. Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9100327. [PMID: 36286279 PMCID: PMC9604661 DOI: 10.3390/jcdd9100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
This randomized study aims to compare the left atrial (LA) lesion size, function, and tissue damage following pulmonary vein isolation (PVI) by high-power short-duration (HPSD) radiofrequency (RF) and second-generation cryoballoon (CB2) ablation. We enrolled 40 patients with paroxysmal atrial fibrillation who underwent PVI by HPSD RF (n = 21) or CB2 (n = 19). Every patient underwent LA CT angiography and transthoracic echocardiography (TTE) to assess the LA anatomy and function. Biomarker levels (hs-cTnT, hs-CRP, LDH) were compared pre- and post-procedurally. Pre- and post-ablation high-density mapping (HDM) was performed. The isolation area was defined under 0.2 mV bipolar voltage (low voltage area, LVA). We calculated the post-PVI LVA/LA surface ratio using LA CT-HDM merge images. At 3-month follow-up, TTE was performed to assess the changes in LA function. Post-ablation hs-cTnT level was significantly higher in the RF group (RF: 1249 ± 469 ng/L, CB2: 995 ± 280 ng/L, p = 0.024). Post-PVI hs-CRP (RF: 9.53 ± 10.30 mg/L, CB2: 12.36 ± 5.76 mg/L, p = 0.034) and LDH levels (RF: 349.9 ± 65.6 U/L, CB2: 451.6 ± 91.3 U/L, p < 0.001) were significantly higher following CB2 ablation. Post-PVI LVA/LA surface ratios were 8.37 ± 6.42% in the RF group and 13.58 ± 8.92% in the CB2 group (p = 0.022). LA function did not change significantly after the PVI procedure. Our data indicate that second-generation cryoballoon ablation produces a significantly larger LA lesion size compared to “point-by-point” HPSD radiofrequency. Both techniques preserve LA function. The myocardial component of tissue loss appears to be higher using HPSD radiofrequency ablation, with less collateral damage.
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Affiliation(s)
- Krisztian Istvan Kassa
- Karoly Racz Doctoral School of Clinical Medicine, Semmelweis University, 1085 Budapest, Hungary
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
- Correspondence: ; Tel.: +36-305-992-895
| | - Zsofia Nagy
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Daniel Simkovits
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Zsuzsanna Kis
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Tamas Ferenci
- Physiological Controls Research Center, Obuda University, 1034 Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Zoltan Som
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Csaba Foldesi
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
| | - Attila Kardos
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary
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Kupusovic J, Kessler L, Nekolla SG, Riesinger L, Weber MM, Ferdinandus J, Kochhäuser S, Rassaf T, Wakili R, Rischpler C, Siebermair J. Visualization of thermal damage using 68 Ga-FAPI-PET/CT after pulmonary vein isolation. Eur J Nucl Med Mol Imaging 2022; 49:1553-1559. [PMID: 34778928 PMCID: PMC8940837 DOI: 10.1007/s00259-021-05612-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/31/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE 68 Ga-fibroblast-activation protein inhibitor (FAPI) positron emission tomography (PET) is a novel technique targeting FAP-alpha. This protein is expressed by activated fibroblasts which are the main contributors to tissue remodeling. The aim of this proof-of-concept study was to assess 68 Ga-FAPI uptake in the pulmonary vein (PV) region of the left atrium after pulmonary vein isolation (PVI) with cryoballoon ablation (CBA) and radiofrequency (RFA) as a surrogate for thermal damage. METHODS Twelve PVI patients (5 RFA, 7 CBA) underwent 68 Ga-FAPI-PET 20.5 ± 12.8 days after PVI. Five patients without atrial fibrillation or previous ablation served as controls. Standardized uptake values of localized tracer uptake were calculated. RESULTS Focal FAPI uptake around the PVs was observed in 10/12 (83.3%) PVI patients, no uptake was observed in 2 PVI patients and all controls. Patients after PVI had higher FAPI uptake in PVs compared to controls (SUVmax: 4.3 ± 2.2 vs. 1.6 ± 0.2, p < 0.01; SUVpeak: 2.9 ± 1.4 vs. 1.3 ± 0.2, p < 0.01). All CBA patients had an intense uptake, while in the RFA, group 2 (40%), 1 (20%), and 2 (40%) patients had an intense, moderate, and no uptake, respectively. We observed higher uptake values (SUVpeak) in CBA compared to RFA patients (4.4 ± 1.5 vs. 2.5 ± 0.8, p = 0.02). CONCLUSION We demonstrate in-vivo visualization of 68 Ga-FAPI uptake as a surrogate for fibroblast activation after PVI. CBA seems to cause more pronounced fibroblast activation following tissue injury than RFA. Future studies are warranted to assess if this modality can contribute to a better understanding of the mechanisms of AF recurrence after PVI by lesion creation and gap assessment.
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Affiliation(s)
- Jana Kupusovic
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Lisa Riesinger
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Manuel M Weber
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Simon Kochhäuser
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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A Systematic Review and Meta-Analysis of the Direct Comparison of Second-Generation Cryoballoon Ablation and Contact Force-Sensing Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation. J Pers Med 2022; 12:jpm12020298. [PMID: 35207786 PMCID: PMC8876986 DOI: 10.3390/jpm12020298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 01/25/2023] Open
Abstract
The superiority of second-generation cryoballoon (2G-CB) ablation versus contact force-sensing radiofrequency (CF-RF) ablation in patients with paroxysmal atrial fibrillation (AF) was assessed in this systematic review and meta-analysis. Freedom from atrial tachyarrhythmias (ATAs) (OR = 0.89; 95% confidence interval [CI] = 0.68 to 1.17; p = 0.41), freedom from AF (OR = 0.93; 95% CI = 0.65 to 1.35; p = 0.72), and acute pulmonary vein isolation (PVI) (OR = 1.17; 95% CI = 0.54 to 2.53; p = 0.70) between 2G-CB ablation and CF-RF ablation were not different. The procedure time for the 2G-CB ablation was shorter (MD = −18.78 min; 95% CI = −27.72 to −9.85 min; p < 0.01), while the fluoroscopy time was similar (MD = 2.66 min; 95% CI = −0.52 to 5.83 min; p = 0.10). In the 2G-CB ablation group, phrenic nerve paralysis was more common (OR = 5.74; 95% CI = 1.80 to 18.31; p = < 0.01). Regarding freedom from ATAs, freedom from AF, and acute PVI, these findings imply that 2G-CB ablation is not superior to CF-RF ablation in paroxysmal AF. Although faster than CF-RF ablation, 2G-CB ablation has a greater risk of phrenic nerve paralysis.
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Shinohara T, Takahashi N, Mukai Y, Kimura T, Yamaguchi K, Takita A, Origasa H, Okumura K. Catheter Ablation Energy Sources and Myocardial Injury and Coagulation Biomarkers During Uninterrupted Periprocedural Edoxaban Use - A Subanalysis of KYU-RABLE. Circ J 2022; 86:280-286. [PMID: 34275977 DOI: 10.1253/circj.cj-21-0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effects of catheter ablation (CA) energy sources on myocardial injury and coagulation biomarkers among Japanese non-valvular atrial fibrillation patients receiving uninterrupted periprocedural edoxaban are unclear. This KYU-RABLE exploratory subanalysis compared the effects of CA using radiofrequency energy vs. cryoballoon on: (1) myocardial injury; and (2) plasma edoxaban and coagulation biomarker concentrations measured before and after CA. METHODS AND RESULTS Plasma creatine kinase (CK), edoxaban, D-dimer, and prothrombin fragment 1+2 (F1+2) concentrations within 1 h before CA were compared with concentrations the day after. All biomarkers increased after CA, regardless of the energy source, but especially with cryoballoon. Significantly higher increases in CK concentrations from before to the day after CA were seen with cryoballoon compared with radiofrequency energy (P<0.0001). Edoxaban concentrations were similar in both groups. Concentrations of D-dimer and F1+2 increased in both groups, but were significantly higher in the cryoballoon group (P<0.0001 and P=0.006, respectively). There were no significant between-group differences in the incidence of thrombotic or bleeding events. CONCLUSIONS Uninterrupted edoxaban concentrations were similar in both groups. Both myocardial injury and coagulation biomarkers increased after CA, especially with cryoballoon, but there was no difference in the incidence of thrombotic or bleeding events. These findings suggest the efficacy of uninterrupted edoxaban, regardless of the CA energy source. Periprocedural anticoagulation, particularly with cryoballoon, should be undertaken with care.
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Affiliation(s)
- Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine
| | - Yasushi Mukai
- Cardiology Division, Japanese Red Cross Fukuoka Hospital
| | | | | | | | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
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11
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Do U, Kim J, Kim M, Cho MS, Nam GB, Choi KJ, Kim YH. Association of pericardial effusion after pulmonary vein isolation and outcomes in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1132-1138. [PMID: 32840867 DOI: 10.1111/pace.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/04/2020] [Accepted: 08/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The clinical implications of pericardial effusion (PE) after catheter ablation for atrial fibrillation (AF) are not well understood. We evaluated the association between newly developed PE after pulmonary vein isolation (PVI) for paroxysmal AF and arrhythmic recurrence. METHODS From a prospective AF ablation registry, 184 patients (mean age 59 ± 10 years, 65% male) who underwent first-time PV isolation using a smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA) were analyzed. Postablation transthoracic echocardiography (TTE) was performed within 1-3 days after ablation, and the occurrence of PE was assessed. RESULTS PE developed in 91 patients (49.5%), and most were of minimal severity (minimal, 93.4%; mild, 6.6%). Patients with PE had significantly lower body mass index and underwent cavotricuspid isthmus ablation more frequently. Early arrhythmic recurrence (EAR) (within 3 months) was observed in 28.8% of patients and was not different according to the PE development (PE [+]: 29.7% vs PE [-]: 28.0%; P = .80). During a median follow-up of 696 days, the cumulative rate of the late arrhythmic recurrence (LAR) (after 3 months) was 36.4%, and there was no difference between groups (PE [+]: 36.7% vs PE [-]: 35.1%; P = .988). The only predictor of LAR was EAR, and no echocardiographic parameters showed a significant correlation with LAR. CONCLUSIONS Minimal or mild PE after PVI for paroxysmal AF is a frequent echocardiographic finding, and it had no significant association with AF recurrence. Routine TTE after AF ablation has no clinical implication.
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Affiliation(s)
- Ungjeong Do
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Ho Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Yano M, Egami Y, Yanagawa K, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Tanaka A, Matsunaga‐Lee Y, Yamato M, Shutta R, Nishino M, Tanouchi J. Comparison of myocardial injury and inflammation after pulmonary vein isolation for paroxysmal atrial fibrillation between radiofrequency catheter ablation and cryoballoon ablation. J Cardiovasc Electrophysiol 2020; 31:1315-1322. [DOI: 10.1111/jce.14475] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Masamichi Yano
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Yasuyuki Egami
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | | | | | | | - Koji Yasumoto
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Masaki Tsuda
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Naotaka Okamoto
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Akihiro Tanaka
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | | | - Masaki Yamato
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Ryu Shutta
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Masami Nishino
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Jun Tanouchi
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
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13
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Fortuni F, Casula M, Sanzo A, Angelini F, Cornara S, Somaschini A, Mugnai G, Rordorf R, De Ferrari GM. Meta-Analysis Comparing Cryoballoon Versus Radiofrequency as First Ablation Procedure for Atrial Fibrillation. Am J Cardiol 2020; 125:1170-1179. [PMID: 32087997 DOI: 10.1016/j.amjcard.2020.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 01/20/2023]
Abstract
Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. Radiofrequency (RF) represents a standard of care for pulmonary vein isolation, whereas cryoballoon (CB) ablation has emerged as a valid alternative. The aim of our meta-analysis was to explore the efficacy and safety of CB compared with RF as first ablation procedure for AF. We searched the literature for studies that investigated this issue. The primary efficacy outcome was AF recurrence. The safety outcomes were: pericardial effusion, cardiac tamponade, phrenic nerve palsy, vascular complications, and major bleedings. Fourteen randomized controlled studies and 34 observational studies were included in the analysis. A total of 7,951 patients underwent CB ablation, whereas 9,641 received RF ablation. Mean follow-up was 14 ± 7 months. Overall, CB reduced the incidence of AF recurrence compared with RF ablation (relative risk [RR] 0.86; 95% confidence interval [CI] 0.78 to 0.94; p = 0.001), and this result was consistent across different study design and AF type. CB had a significantly higher rate of phrenic nerve palsy, whereas it was related to a lower incidence of pericardial effusion, cardiac tamponade (RR 0.58; 95% CI 0.38 to 0.88; p = 0.011) and vascular complications (RR 0.61; 95% CI 0.48 to 0.77; p <0.001) compared with RF. There was no significant difference in major bleedings between the 2 strategies. CB ablation had a shorter procedural time compared with RF (mean difference -20.76 minutes; p <0.001). In conclusion, considered its efficacy/safety profile and short procedural time, CB ablation represents the preferable option for first AF ablation procedure.
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14
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Xiao FY, Ju WZ, Chen HW, Huang WJ, Chen M. A comparative study of pericardial effusion and pleural effusion after cryoballoon ablation or radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:1062-1067. [PMID: 32108393 DOI: 10.1111/jce.14423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The incidence and clinical outcome of pericardial and pleural effusion after cryoballoon ablation (CBA) or radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) have not been fully investigated. METHODS A total of 60 patients with paroxysmal AF were treated with either CBA (n = 30) or RFCA (n = 30) groups, with assessment of serum troponin I level, left atrial pulmonary vein computed tomography (CT) angiography and echocardiography within 24 hours before ablation, and serum troponin I level at 12 hours, and chest CT and echocardiography within 24 hours postablation. Repeat chest CT was performed 1 month after the index procedure in patients with pericardial or pleural effusion. RESULTS With similarly distributed baseline characteristics, the CBA group relative to the RFCA group had postablation: higher serum troponin I level (13.48 vs 1.84 µg/L, P < .001); similarly high pericardial effusion rates on chest CT (80% vs 93.3%, P > .05), with chest CT yielding significantly higher detection rate than echocardiography; similarly high pleural effusion rates on chest CT (73.3% vs 80%, P > .05); and smaller maximum depths on chest CT cross-section of pericardial effusion (5.21 ± 3.37 vs 7.13 ± 2.68 mm, P < .05) and pleural effusion bilaterally (left: 4.16 ± 4.90 vs 6.96 ± 5.42 mm; right: 5.04 ± 4.46 vs 7.55 ± 4.95 mm, both P < .05). The effusions self-resolved within a mean period of 1 month. CONCLUSIONS Both CBA and RFCA were associated with high rates of pericardial and pleural effusion, with RFCA yielding numerically higher incidence and significantly higher effusion extent, and chest CT significantly higher detection rates than echocardiography.
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Affiliation(s)
- Fang Yi Xiao
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Zhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Jian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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15
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Yanagisawa S, Inden Y, Fujii A, Sakamoto Y, Tomomatsu T, Mamiya K, Okamoto H, Shibata R, Murohara T. Prothrombotic Responses After Catheter Ablation for Atrial Fibrillation During Uninterrupted Oral Anticoagulant Agent Administration. JACC Clin Electrophysiol 2019; 5:1418-1427. [PMID: 31857041 DOI: 10.1016/j.jacep.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the extent of changes in prothrombotic responses after catheter ablation for atrial fibrillation (AF) under uninterrupted oral anticoagulant agent (OAC) administration. BACKGROUND Catheter ablation for AF has a potential risk for prothrombotic activation and silent thromboembolic events. METHODS A total of 814 patients (n = 172 [warfarin], n = 153 [dabigatran], n = 134 [rivaroxaban], and n = 301 [apixaban] patients undergoing AF ablation and a control group of 54 patients undergoing non-AF ablation) were included. Uninterrupted OACs were administered during the procedure in patients with AF. Blood samples were collected the day before and 3 days after the procedure. RESULTS At baseline, D-dimer levels were within normal limits (≤1.0 μg/ml) in more than 90% of the patients in all groups. However, after 3 days, this proportion decreased to 67%, 73%, 59%, 68%, and 65% in the warfarin, dabigatran, rivaroxaban, apixaban, and control groups, respectively (p = 0.180). Changes in prothrombin fragment 1+2 levels differed (p < 0.001), whereas fibrin monomer complex levels 3 days after ablation at a trough were equivalent within normal ranges among the groups (p = 0.146). Multivariate analysis revealed that age, CHA2DS2-VASc score, first session, and radiofrequency ablation were independent predictors of increased D-dimer levels after the procedure. Various changes in prothrombotic markers were observed between the warfarin and direct OAC groups after propensity score matching analyses. CONCLUSIONS The coagulation cascade was activated after catheter ablation for AF under uninterrupted OAC administration. The changes in various prothrombotic markers differed among the OAC groups.
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Affiliation(s)
- Satoshi Yanagisawa
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiro Tomomatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Mamiya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroya Okamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Nagao T, Higo S, Suzuki H, Teshima Y, Matsunaga S, Harada K, Shinoda N, Harada K, Kato M, Marui N, Amano T, Inden Y, Murohara T. Prospective comparison of periprocedural coagulation markers among uninterrupted anticoagulants for atrial fibrillation ablation. Heart Rhythm 2019; 17:391-397. [PMID: 31606462 DOI: 10.1016/j.hrthm.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The difference in coagulation state during the periprocedural period of atrial fibrillation (AF) ablation among patients with uninterrupted anticoagulation has not been fully elucidated. OBJECTIVE The purpose of this study was to compare periprocedural trends in coagulation markers among patients on uninterrupted anticoagulation for AF ablation. METHODS In total, 275 consecutive patients who underwent AF ablation were evaluated. These patients were divided according to the anticoagulant they received into the dabigatran group (DG) (n = 64); rivaroxaban group (RG) (n = 62); apixaban group (AG) (n = 60); edoxaban group (EG) (n = 59); and warfarin group (WG) (n = 30). The trends in coagulation markers and the rate of silent stroke (SS) confirmed by postoperative magnetic resonance imaging were evaluated. RESULTS The fibrin monomer complex (FMC) level on postoperative day 1 and the prothrombin fragment 1+2 (PF1+2) levels on the operative day and postoperative day 1 were higher in DG than in the other groups (P <.05, <.001, and <.001, respectively). The incidence of SS in DG (17%) was significantly higher than in RG (6%), AG (3%, EG (7%), or WG (4%) (P <.05). Dabigatran use independently predicted the occurrence of SS (odds ratio 4.12; 95% confidence interval 1.37-12.7; P <.05). CONCLUSION FMC and PF1+2 levels during the periprocedural period of AF ablation were higher in DG than in the other groups. Dabigatran use independently predicted the occurrence of SS.
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Affiliation(s)
- Tomoyuki Nagao
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan.
| | - Sayaka Higo
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Hitomi Suzuki
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Yuto Teshima
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Syun Matsunaga
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | | | - Ken Harada
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Masataka Kato
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Nobuyuki Marui
- Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi-Medical University, Nagakute, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zeljkovic I, Knecht S, Pavlovic N, Celikyrut U, Spies F, Burri S, Mannhart D, Peterhans L, Reichlin T, Schaer B, Osswald S, Sticherling C, Kuhne M. High-sensitive cardiac troponin T as a predictor of efficacy and safety after pulmonary vein isolation using focal radiofrequency, multielectrode radiofrequency and cryoballoon ablation catheter. Open Heart 2019; 6:e000949. [PMID: 31168374 PMCID: PMC6519429 DOI: 10.1136/openhrt-2018-000949] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/26/2019] [Accepted: 03/19/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction Myocardial injury markers such as high-sensitive cardiac troponin T (hs-cTnT) and creatine kinase MB (CK-MB) reflects the amount of myocardial injury with ablation. The aim of the study was to identify the value of myocardial injury markers to predict outcomes after pulmonary vein isolation (PVI) using three different ablation technologies. Methods Consecutive patients undergoing PVI using a standard 3.5 mm irrigated-tip radiofrequency catheter (RF-group), an irrigated multielectrode radiofrequency catheter (IMEA-group) and a second-generation cryoballoon (CB-group) were analysed. Blood samples to measure injury markers were taken before and 18-24 hours after the ablation. Procedural complications were collected and standardised follow-up was performed. Logistic regression was used to identify predictors of recurrence and complications. Results 96 patients (RF group: n=40, IMEA-group: n=17, CB-group: n=39) undergoing PVI only were analysed (82% male, age 59±10 years). After a follow-up of 12 months, atrial fibrillation (AF) recurred in 45% in the RF-group, 29% in the IMEA-group and 36% in the CB-group (p=0.492). Symptomatic pericarditis was observed in 20% of patients in the RF-group, 15% in the IMEA-group and 5% in the CB-group (p=0.131). None of the injury markers was predictive of AF recurrence or PV reconnection after a single procedure. However, hs-cTnT was identified as a predictor of symptomatic pericarditis (OR: 1.003 [1.001 to 1.005], p=0.015). Conclusion Hs-cTnT and CK-MB were significantly elevated after PVI, irrespective of the ablation technology used. None of the myocardial injury markers were predictive for AF recurrence or PV reconnection, but hs-cTnT release predicts the occurrence of symptomatic pericarditis after PVI.
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Affiliation(s)
- Ivan Zeljkovic
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Nikola Pavlovic
- Cardiology, Klinicki bolnicki centar Sestre milosrdnice, Zagreb, Croatia
| | | | - Florian Spies
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Sarah Burri
- Cardiology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Beat Schaer
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Michael Kuhne
- Cardiology, University Hospital Basel, Basel, Switzerland
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