1
|
Perelshtein Brezinov O, Sevylia Z, Rahkovich M, Kakzanov Y, Yahud E, Fortis L, Kogan Y, Asher E, Lev E, Laish-Farkash A. Measurements of immature platelet fraction and inflammatory markers in atrial fibrillation patients - Does persistency or ablation affect results? Int J Lab Hematol 2020; 43:602-608. [PMID: 33289968 DOI: 10.1111/ijlh.13426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Atrial fibrillation (AF) is associated with platelet hyperactivity and a higher proportion of immature platelets. We aimed to examine whether immature platelet fraction (IPF) and inflammatory markers differ between AF types and whether they are affected by ablation. METHODS A prospective study included patients with atrial fibrillation/flutter (AFL). We excluded patients with hematologic, inflammatory, or acute coronary states. Blood samples for IPF, white blood cells (WBC), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) were collected at baseline, within one-hour postablation in those undergoing ablations, and the day after ablation. IPF was measured by an autoanalyzer (Sysmex 2100 XE). RESULTS One hundred and four patients were included (paroxysmal AF-63, persistent AF-36, AF and AFL-7, AFL alone-5), (Mean age 67.7 ± 12.8 years, 54.8% male, CHA2 D2 -VASC2 3.2 ± 1.8). Seventy-two patients underwent ablation (cryoballoon AF ablation-60, AFL radiofrequency ablation-5, both-7). There was no difference between paroxysmal and persistent AF regarding baseline markers. There was a significant change in the following parameters after ablation: WBC (baseline 6.9 ± 2.0, 1-h post 8.0 ± 2.4, and 1-day post 9.0 ± 2.8 ×109 /L), NLR (2.9 ± 2.2, 3.0 ± 2.4, 4.2 ± 2.9, respectively), and CRP (3.6 ± 3.7, 3.6 ± 3.5, 12.4 ± 9.0 mg/L, respectively) (P < .05 for all). However, there were no differences in immature platelet count (8.6 ± 4.8, 8.5 ± 4.9, 8.4 ± 5.2 ×109 /L) or IPF (4.6 ± 3.2, 4.7 ± 3.3, 4.9 ± 3.6%) from baseline to postablation (p = NS). CONCLUSIONS AF persistency does not affect IPF and inflammation. In patients undergoing cryoablation of AF, there is a postablation inflammatory process; however, platelet activation is probably not affected.
Collapse
Affiliation(s)
- Olga Perelshtein Brezinov
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Ziv Sevylia
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Michael Rahkovich
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Yana Kakzanov
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Ella Yahud
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Lior Fortis
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Yonatan Kogan
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eli Lev
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| | - Avishag Laish-Farkash
- Department of Cardiology, Assuta Ashdod University Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
| |
Collapse
|
2
|
Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2020; 61:559-566. [DOI: 10.1007/s10840-020-00835-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Siontis KC, Jamé S, Sharaf Dabbagh G, Latchamsetty R, Jongnarangsin K, Morady F, Bogun FM. Thromboembolic prophylaxis protocol with warfarin after radiofrequency catheter ablation of infarct-related ventricular tachycardia. J Cardiovasc Electrophysiol 2018; 29:584-590. [DOI: 10.1111/jce.13418] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sina Jamé
- Division of Cardiovascular Medicine; University of Michigan; Ann Arbor MI USA
| | | | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine; University of Michigan; Ann Arbor MI USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine; University of Michigan; Ann Arbor MI USA
| | - Fred Morady
- Division of Cardiovascular Medicine; University of Michigan; Ann Arbor MI USA
| | - Frank M. Bogun
- Division of Cardiovascular Medicine; University of Michigan; Ann Arbor MI USA
| |
Collapse
|
5
|
Weber H, Sagerer-Gerhardt M, Heinze A. Laser catheter ablation of long- lasting persistent atrial fibrillation: Longterm results. J Atr Fibrillation 2017; 10:1588. [PMID: 29250231 DOI: 10.4022/jafib.1588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/15/2017] [Accepted: 08/20/2017] [Indexed: 11/10/2022]
Abstract
Catheter ablation of atrial fibrillation (AF) is a current therapeutic option but its efficacy for the treatment of long-lasting persistent AF (l-lpAF) remains suboptimal. We tested the laser method as an alternative for catheter ablation of l-lpAF by using an open-irrigated electrode laser mapping and ablation (ELMA) catheter. Laser ablation was attempted in 48 patients aged 50-81 years (69 ± 7.6 y, female = 28) with drug resistant (3.5 trials) l-lpAF (≥12 months). All of the patients had comorbidities: congestive heart failure NYHA II-III (100%), hypertension 29 (60%), coronary artery disease 19 (40%), and heart valve defect 17 (35%). None of the patients had diabetes or obstructive sleep apnea. All were in AF at the beginning of the procedure. Continuous wave (cw) 1064nm Nd:YAG laser applications at 15W/10-20s (14-26/patient) were applied via the ELMA catheter until local electrical activity displayed on the monitor in the bipolar focused local electrograms (LEG) recorded via the pin electrodes from the tip of the catheter was abolished permanently and sinus rhythm was achieved. Online monitoring of electrical potential amplitudes in the focused LEG recorded via the pin-electrodes of the ELMA catheter allowed for validation of ablation success. Procedure duration ranged from 82-175 min (118 ± 72 min), number of lesions were14-26 (19 ± 4) per patient and X-ray exposure times ranged from 15-82 min (23.2 ± 12 min). Interventions were without complications. After the ablation procedure all the patients were in sinus rhythm, off medication, however, 12 (25%) needed a repeat study for various arrhythmias. During followup of 9 months to 29.3 years (8.2 ± 6.5 years) patients' quality of life improved significantly and during final follow-up control all except two were off medication still in sinus rhythm (lifelong success rate = 96%). As compared to other catheter ablation methods the laser method is an intriguing alternative for catheter ablation of l-lpAF.
Collapse
Affiliation(s)
- Helmut Weber
- CCEP-Center Taufkirchen, Section Research Development Education, Taufkirchen, D- 82024 Taufkirchen, Germany.,Laser and Applied Technologies Center, Hospital Harlaching, Teaching Hospital of the LMUniversity of Munich, Munich, D-81545; Germany
| | - Michaela Sagerer-Gerhardt
- CCEP-Center Taufkirchen, Section Research Development Education, Taufkirchen, D- 82024 Taufkirchen, Germany.,Department of Anesthesiology, Hospital Neuperlach, Teaching Hospital of the LM-University of Munich, Munich, D-81737, Germany
| | - Armin Heinze
- CCEP-Center Taufkirchen, Section Research Development Education, Taufkirchen, D- 82024 Taufkirchen, Germany.,Laser and Applied Technologies Center, Hospital Harlaching, Teaching Hospital of the LMUniversity of Munich, Munich, D-81545; Germany
| |
Collapse
|
6
|
Pieragnoli P, Gori AM, Ricciardi G, Carrassa G, Checchi L, Michelucci A, Priora R, Cellai AP, Marcucci R, Padeletti L, Abbate R. Effects of cryoablation and radiofrequency ablation on endothelial and blood clotting activation. Intern Emerg Med 2014; 9:853-60. [PMID: 24950960 DOI: 10.1007/s11739-014-1090-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
Cryoablation (CA) emerged as an alternative procedure to radiofrequency (RF). The aim of this study was to compare haemostatic system alterations in patients undergoing RF or CA for atrioventricular nodal reentrant tachycardia ablation. von Willebrand factor (vWF), spontaneous whole blood platelet aggregation, prothrombin fragment F1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), plasminogen activator inhibitor type-1 (PAI-1), and clot lysis time (CLT) were determined in 48 patients (27 CA; 21 RF; 19M/29F, mean age 49.6 ± 17.6 years). Blood samples were obtained before the procedure (T0), immediately after (T1), and 24 h later (T2). At T1 both procedures were associated with a significant increase in levels of the endothelial activation marker vWF. At T2 vWF levels were lower in CA than in RF group. No changes in whole blood platelet aggregation before and after ablation procedures were observed. At T1 both groups determined an increase in blood clotting activation markers, F1 + 2, TAT, and DD. At T2 F1 + 2, TAT and DD levels were similar to baseline values. The comparison between RF and CA showed no significant differences in F1 + 2 and TAT levels, whereas at T1 DD levels were higher in CA group than in RF group. Both procedures induced a significant decrease in CLT, whereas no changes in PAI-1 levels were found. There were no significant differences in CLT and PAI-1 levels. The fibrinolytic efficiency analysis showed that at T1 DD/TAT and DD/F1 + 2 ratios were lower in RF group and remained lower in RF than in CA group at T2. CA procedure may be associated with a lower degree of endothelial damage and with a higher fibrinolytic capacity respect to RF.
Collapse
Affiliation(s)
- Paolo Pieragnoli
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Neurologic complications of catheter ablation/defibrillators/pacemakers. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 24365294 DOI: 10.1016/b978-0-7020-4086-3.00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Approaches to the management of patients with cardiac arrhythmias have significantly evolved over the last decade, with advancement in catheter ablation and device implantation techniques. As the techniques and tools evolve, so does our understanding of the possible complications from these procedures. The focus of this chapter is discussion of the neurologic complications involved with catheter ablation, pacemaker and defibrillation implantation, with the focus on timely diagnosis, and management strategies.
Collapse
|
8
|
Giglia TM, Massicotte MP, Tweddell JS, Barst RJ, Bauman M, Erickson CC, Feltes TF, Foster E, Hinoki K, Ichord RN, Kreutzer J, McCrindle BW, Newburger JW, Tabbutt S, Todd JL, Webb CL. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease. Circulation 2013; 128:2622-703. [DOI: 10.1161/01.cir.0000436140.77832.7a] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
9
|
Weber HP, Sagerer-Gerhardt M. Open-irrigated laser catheter ablation produces flow-dependent sizes of lesions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1132-7. [PMID: 23663238 DOI: 10.1111/pace.12152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Growth and sizes of lesions produced during catheter ablation is difficult to control. Laser lesion formation was evaluated during various flow rates and energy settings by using an open-irrigated laser catheter on a thigh-muscle dog model. METHODS Laser radiation at 15 W or 20 W was applied in blood for 10 seconds, 20 seconds, 30 seconds, 40 seconds, and 50 seconds during an irrigation flow of 16 mL/min or 35 mL/min, in direct contact, and in a noncontact mode of laser application. Lesions were evaluated morphometrically. RESULTS There was a linear increase of lesions with the increase of the level of energy applied. Maximal depth of lesions achieved during a flow rate of 16 mL/min at 15 W/50 seconds increased significantly from 9.9 ± 0.3 mm to 12.1 ± 0.5 mm, and at 20 W/50 seconds from 11.1 ± 0.55 mm to 12.4 ± 0.26 mm, when irrigation flow was 35 mL/min (P < 0.5). However, difference of lesion increase between 15 W and 20 W was not significant (P = 0.30). Lesions were achieved also in a noncontact mode of radiation at a distance of 1-2 mm, but not at 5 mm away. Radiation at 20 W > 40 seconds and a flow rate of 35 mL/min may cause steam pop with intramural cavitation. CONCLUSIONS By using an open-irrigated laser catheter augmentation of catheter flow increases lesion sizes. Lesions can be achieved also in a noncontact mode of radiation. In order to avoid unwanted effects the level of energy applied must be limited.
Collapse
|
10
|
DUYTSCHAEVER MATTIAS, BERTE BENJAMIN, ACENA MARTA, DE MEYER GRIM, BUN SOKSITHIKUN, VAN HEUVERSWYN FREDERIC, VANDEKERCKHOVE YVES, TAVERNIER RENE. Catheter Ablation of Atrial Fibrillation in Patients at Low Thrombo-Embolic Risk: Efficacy and Safety of a Simplified Periprocedural Anticoagulation Strategy. J Cardiovasc Electrophysiol 2013; 24:855-60. [DOI: 10.1111/jce.12148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 03/07/2013] [Accepted: 03/15/2013] [Indexed: 01/05/2023]
Affiliation(s)
- MATTIAS DUYTSCHAEVER
- Department of Cardiology; St.-Jan Hospital Bruges Belgium
- Department of Cardiology; Ghent University Hospital Ghent Belgium
| | - BENJAMIN BERTE
- Department of Cardiology; St.-Jan Hospital Bruges Belgium
| | - MARTA ACENA
- Department of Cardiology; St.-Jan Hospital Bruges Belgium
| | - GRIM DE MEYER
- Department of Cardiology; St.-Jan Hospital Bruges Belgium
| | | | | | | | - RENE TAVERNIER
- Department of Cardiology; St.-Jan Hospital Bruges Belgium
| |
Collapse
|
11
|
Bhave PD, Knight BP. Optimal Strategies Including Use of Newer Anticoagulants for Prevention of Stroke and Bleeding Complications Before, During, and After Catheter Ablation of Atrial Fibrillation and Atrial Flutter. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:450-66. [PMID: 23568665 DOI: 10.1007/s11936-013-0242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Prashant D Bhave
- Cardiology Division/Electrophysiology Section, Northwestern University Feinberg School of Medicine, 676 North St. Claire, Suite 600, Chicago, IL, 60611, USA,
| | | |
Collapse
|
12
|
|
13
|
Aldhoon B, Wichterle D, Peichl P, Čihák R, Kautzner J. Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography. ACTA ACUST UNITED AC 2012; 15:24-32. [DOI: 10.1093/europace/eus304] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012; 9:1006-24. [PMID: 22579340 DOI: 10.1016/j.hrthm.2012.03.050] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
-
- Arizona Pediatric Cardiology Consultants & Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Efficacy of pulmonary vein isolation with a novel hot balloon ablation catheter. J Interv Card Electrophysiol 2012; 34:29-36. [DOI: 10.1007/s10840-011-9646-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022]
|
16
|
Parizek P, Haman L, Pleskot M, Pecka M, Bukac J, Stransky P, Maly J. Hemostatic changes before and during electrophysiologic study and radiofrequency catheter ablation. Int J Hematol 2011; 93:452-457. [PMID: 21387091 DOI: 10.1007/s12185-011-0806-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 02/22/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
We sought to investigate specific hemostasis activation markers during electrophysiologic study (EPS) with consequent radiofrequency catheter ablation (RFA). Sixty patients were studied prospectively during routine EPS with RFA for paroxysmal supraventricular tachycardia. Blood samples were drawn before the insertion of venous sheaths (T0), at the end of EPS (T1), and 30 min after completion of RFA (T2). To study coagulation and fibrinolytic and platelet activity, we measured concentrations of thrombin-antithrombin III (TAT), D-dimers (DD), plasminogen activator inhibitor type 1 (PAI-1), tissue-type plasminogen activator (t-PA), and circulating platelet aggregates. The results are expressed as median and show 95% confidence levels. Levels of DD increased from 0.24 mg/L at T0 to 0.37 mg/L at T1 (P < 0.001) and to 0.59 mg/L at T2 (P < 0.001). TAT levels increased from 5.29 μg/L at T0 to 35.80 μg/L at T1 (P < 0.001) and decreased to 26.30 μg/L at T2 (P < 0.001). PAI-1 concentration decreased from 30.10 μg/L at T0 to 26.4 μg/L at T1 (P < 0.001). t-PA at T2 increased to 5.10 μg/L from 4.75 μg/L at T1 (P = 0.001). No other differences between corresponding medians were statistically significant (P > 0.05). We found that concentrations of DD at T2 versus T1 depended on the number of radiofrequency energy applications (r (S) = 0.387; P = 0.002). Marked platelet activation was observed from the start of the procedure, without changes during the procedure.
Collapse
Affiliation(s)
- Petr Parizek
- 1st Department of Internal Medicine, University Hospital, 500 05, Hradec Kralove, Czech Republic.
| | - L Haman
- 1st Department of Internal Medicine, University Hospital, 500 05, Hradec Kralove, Czech Republic
| | - M Pleskot
- 1st Department of Internal Medicine, University Hospital, 500 05, Hradec Kralove, Czech Republic
| | - M Pecka
- 2nd Department of Internal Medicine, University Hospital, Hradec Kralove, Czech Republic
| | - J Bukac
- Department of Medical Biophysics, Faculty of Medicine, Charles University Prague, Hradec Kralove, Czech Republic
| | - P Stransky
- Department of Medical Biophysics, Faculty of Medicine, Charles University Prague, Hradec Kralove, Czech Republic
| | - J Maly
- 2nd Department of Internal Medicine, University Hospital, Hradec Kralove, Czech Republic
| |
Collapse
|
17
|
Russo AM. Is performance of routine transesophageal echocardiography justified prior to catheter ablation for atrial fibrillation? J Cardiovasc Electrophysiol 2009; 20:1223-6. [PMID: 19602029 DOI: 10.1111/j.1540-8167.2009.01555.x] [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] [Indexed: 11/27/2022]
|
18
|
Tse HF, Kwong YL, Lau CP. Transvenous Cryoablation Reduces Platelet Activation During Pulmonary Vein Ablation Compared with Radiofrequency Energy in Patients with Atrial Fibrillation. J Cardiovasc Electrophysiol 2005; 16:1064-70. [PMID: 16191116 DOI: 10.1111/j.1540-8167.2005.50103.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiofrequency (RF) ablation procedures for atrial fibrillation (AF) are associated with potential risks of thromboembolism, which may be minimized by the use of cryoablation that preserves the integrity of endocardium. The objective of this study was to compare the thrombogenic potential of transvenous cryoablation versus RF ablation during pulmonary vein (PV) isolation. METHODS AND RESULTS Thirty consecutive patients with paroxysmal AF were randomized to undergo segmental PV isolation procedure using 4-mm tip RF ablation (n = 15) or cryoablation (CryoCor, San Diego, CA, USA) (n = 15). Blood samples were drawn after sheath insertion (baseline), after transseptal puncture, before ablation (after heparin administration), and after isolation of a superior PV. Activation of coagulation was measured with plasma levels of prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), and platelets by plasma level of beta-thromboglobulin (beta-TG) and flow cytometric enumerating of P-selectin (CD62)-positive platelets. In both groups, the plasma level of beta-TG, F1 + 2, and TAT were elevated after sheath insertion. The percentage changes in plasma level of beta-TG, F1 + 2, and TAT and CD41/62-positive platelets from baseline after transseptal puncture and before ablation were similar (P > 0.05). However, the percentage changes in CD62-positive platelets from baseline were significantly higher in patients treated with RF ablation (82 +/- 20%) than with cryoablation (22 +/- 14%, P = 0.02), although their plasma levels of beta-TG, F1 + 2, and TAT were not different (P > 0.05). CONCLUSIONS Significant platelet and coagulation activations were observed during PV ablation procedures, and heparin administration only prevented activation of coagulation but not platelets. Persistent platelets activation was observed during RF energy application, but not during cryoablation.
Collapse
Affiliation(s)
- Hung-Fat Tse
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong.
| | | | | |
Collapse
|
19
|
Reek S, Geller JC, Schildhaus HU, Ripley KL, Klein HU. Feasibility of Catheter Cryoablation in Normal Ventricular Myocardium and Healed Myocardial Infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1530-9. [PMID: 15546309 DOI: 10.1111/j.1540-8159.2004.00672.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although novel cryoablation systems have recently been introduced into clinical practice for catheter ablation of supraventricular tachycardia, the feasibility of catheter cryoablation of VT is unknown. Thus, the present study evaluates catheter cryoablation of the ventricular myocardium (1) in healthy sheep and (2) of VT in chronic myocardial infarction (MI). In three healthy sheep, 21 ventricular lesions (12 left and 9 right ventricle) were created with a catheter cryoablation system. Different freeze/thaw characteristics were used for lesion creation. The mean nadir temperature was -84.1 degrees C +/- 0.9 degrees C, mean lesion volume was 175.8 +/- 170.3 mm3, and 5 of 21 lesions were transmural. Lesion dimensions were 7.5 +/- 3.1 mm (width) and 4.2 +/- 2.5 mm (depth). Left ventricular lesions were significantly larger than right ventricular lesions (262 +/- 166 vs 60.5 +/- 91.6 mm3, P=0.0025). There was no difference in lesion volume with respect to different freeze/thaw characteristics. Anatomically (n=3) or electrophysiologically (n=3) guided catheter cryoablation was attempted in six sheep 105 +/- 56 days after MI, three of six animals had reproducibly inducible VT with a mean cycle length of 215 +/- 34 ms prior to ablation. In these animals, five VTs were targeted for ablation. A mean of 6 +/- 3 applications for nine left ventricular lesions were applied, six of nine lesions were transmural. The mean lesion volume was 501 +/- 424 mm3. No VT was inducible in two of three animals after cryoablation using an identical stimulation protocol. Therefore, catheter cryoablation of VT in healed MI is feasible, and no acute complications were observed.
Collapse
Affiliation(s)
- Sven Reek
- Division of Cardiology, University Hospital Magdeburg, Germany.
| | | | | | | | | |
Collapse
|
20
|
Charng MJ, Lin YJ, Chiu TY, Cheng CM, Ding PYA. Comparison of hemostatic activation created by right- and left-heart radiofrequency catheter ablation. Clin Cardiol 2004; 27:91-6. [PMID: 14979628 PMCID: PMC6654595 DOI: 10.1002/clc.4960270210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thromboembolic complications commonly occur in radiofrequency (RF) ablation procedures (0.6-1.3% of cases). Comparison of hemostatic activation between left and right RF ablation is limited. HYPOTHESIS The purpose of this study was to evaluate platelet and hemostatic activation before, immediately after, and 48 h following left and right myocardial RF ablation procedures. METHODS The subjects were two groups of patients who underwent right-heart (24 patients) and left-heart (20 patients) RF ablation. Blood samples taken before, immediately after, and 48 h after the procedure were tested for changes in platelet and hemostatic activation. RESULTS No indication of clinically symptomatic thromboembolism and no major differences in baseline characteristics and procedure were apparent in either group, except for a higher temperature mode setting (p < 0.001) in the left-heart group. The hemostatic evaluation levels increased significantly by the end of the procedure in both groups and the platelet activation level remained elevated for 48 h after the procedure. The platelet activation level increased insignificantly at the end and 48 h after the procedure. Of the other changes in levels of platelet and hemostatic activation, only an increase in one of the hemostatic levels in the right-heart group at 48 h after procedure was significant (p = 0.01). CONCLUSIONS Our findings suggest that similar hemostatic activation occurred during and immediately after RF ablation in both groups. Sustained elevation of the hemostatic marker after the ablation procedure in the right-heart group was observed as of significant therapeutic and prognostic implications.
Collapse
Affiliation(s)
- Min-Ji Charng
- Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan.
| | | | | | | | | |
Collapse
|
21
|
Benito Bartolomé F, Sánchez Fernández-Bernal C, Prada Martínez F. [Pulmonary thromboembolism associated with radiofrequency catheter ablation]. Rev Esp Cardiol 2003; 56:1147-8. [PMID: 14622549 DOI: 10.1016/s0300-8932(03)77028-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
22
|
Khairy P, Chauvet P, Lehmann J, Lambert J, Macle L, Tanguay JF, Sirois MG, Santoianni D, Dubuc M. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003; 107:2045-50. [PMID: 12668527 DOI: 10.1161/01.cir.0000058706.82623.a1] [Citation(s) in RCA: 348] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation is limited by thromboembolic complications. The objective of this study was to compare the incidence and characteristics of thrombi complicating RF and cryoenergy ablation, a novel technology for the catheter-based treatment of arrhythmias. METHODS AND RESULTS Ablation lesions (n=197) were performed in 22 mongrel dogs at right atrial, right ventricular, and left ventricular sites preselected by a randomized factorial design devised to compare RF ablation with cryocatheter configurations of varying sizes (7F and 9F), cooling rates (-1 degrees C/s, -5 degrees C/s, and -20 degrees C/s) and target temperatures (-55 degrees C and -75 degrees C). Animals were pretreated with acetylsalicylic acid and received intraprocedural intravenous unfractionated heparin. Seven days after ablation, the incidence of thrombus formation was significantly higher with RF than with cryoablation (75.8% versus 30.1%, P=0.0005). In a multiple regression model, RF energy remained an independent predictor of thrombus formation compared with cryoenergy (OR, 5.6; 95% CI, 1.7, 18.1; P=0.0042). Thrombus volume was also significantly greater with RF than with cryoablation (median, 2.8 versus 0.0 mm3; P<0.0001). More voluminous thrombi were associated with larger RF lesions, but cryolesion dimensions were not predictive of thrombus size. CONCLUSIONS RF energy is significantly more thrombogenic than cryoenergy, with a higher incidence of thrombus formation and larger thrombus volumes. The extent of hyperthermic tissue injury is positively correlated with thrombus bulk, whereas cryoenergy lesion size does not predict thrombus volume, most likely reflecting intact tissue ultrastructure with endothelial cell preservation.
Collapse
Affiliation(s)
- Paul Khairy
- Department of Electrophysiology, Montreal Heart Institute, Quebec, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Sasano T, Hirao K, Yano K, Kawabata M, Okishige K, Isobe M. Delayed thrombogenesis following radiofrequency catheter ablation. Circ J 2002; 66:671-6. [PMID: 12135137 DOI: 10.1253/circj.66.671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The cause and duration of the thrombogenesis provoked by radiofrequency catheter ablation (RF-CA) was investigated by measuring the thrombin-antithrombin III complex (TAT) in 43 patients who underwent RF-CA and in 20 control subjects who underwent an electrophysiologic study. Blood samples were collected at 7 different times: before introducing the sheaths, during the ablation procedure and at 30 min, 6 and 24h, and 3 and 6 days after the procedure. Hepatocyte growth factor (HGF) was simultaneously measured in the ablation group. Plasma TAT concentration exhibited a double peaked pattern in the ablation group: the first peak occurred during the ablation procedure (42.8+/-15.5 ng/ml), and the second peak 3 days later. Plasma TAT at 3 days after the procedure was significantly higher than that of the control group (21.3+/-19.0 vs 2.5+/-1.4, p=0.0003). The first peak significantly correlated with the procedure time prior to the administration of heparin (r=0.669), but the second peak did not (r=0.132). A subgroup with a serum HGF >0.40 ng/ml at 6 h after the procedure exhibited a significantly high second peak. The thrombogenesis caused by RF-CA has 2 phases; in the acute phase, there is hemostasis during placement of the catheters, and in the delayed phase thrombogenesis is the result of endothelial damage from the RF current.
Collapse
Affiliation(s)
- Tetsuo Sasano
- Cardiovascular Department, Yokohama Red Cross Hospital, Japan.
| | | | | | | | | | | |
Collapse
|
24
|
Etheridge SP. Radiofrequency catheter ablation of left-sided accessory pathways in pediatric patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2001; 13:11-24. [PMID: 11413055 DOI: 10.1016/s1058-9813(01)00080-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In many cases, radiofrequency catheter ablation has replaced the long-term use of antiarrhythmic medication for symptomatic tachycardia, and has all but eliminated arrhythmia surgery. The most common substrate for radiofrequency catheter ablation in pediatric patients is atrioventricular (AV) reentry tachycardia due to a concealed or manifest accessory pathway. Accessory pathways are distributed unevenly along the right and left atrioventricular valve annuli, and left-sided accessory pathways are most common. Although some centers advocate an abbreviated diagnostic and mapping approach to both concealed and manifest left-sided accessory pathways, most still use a complete electrophysiological evaluation and complex catheter manipulation for mapping, followed by the application of radiofrequency energy. Left-sided accessory pathways may be approached from the transatrial approach, the retrograde aortic approach, or less commonly from within the coronary sinus. Each approach has proven to be associated with success, but also with a distinct set of risks. Possibly because left-sided accessory pathways are most common, catheter ablation of this substrate has proven highly successful and has the lowest risk of recurrence. However, recent data also suggest that this substrate is associated with greater risk of complications than of right-sided accessory pathways or pathways located in the posteroseptal region. The following report reviews some of the recently described diagnostic and mapping techniques, success rates, risks and follow-up data in pediatric patients undergoing radiofrequency catheter ablation of left-sided accessory pathways.
Collapse
Affiliation(s)
- S P. Etheridge
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
25
|
Weber H, Heinze A. Laser Catheter Ablation of Cardiac arrhythmias. BIOMED ENG-BIOMED TE 2001. [DOI: 10.1515/bmte.2001.46.s2.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
26
|
Schaffer MS, Gow RM, Moak JP, Saul JP. Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry). Participating members of the Pediatric Electrophysiology Society. Am J Cardiol 2000; 86:639-43. [PMID: 10980215 DOI: 10.1016/s0002-9149(00)01043-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Deaths have been reported following radiofrequency catheter ablation (RFCA), but the mortality rate in children has not been defined. This study sought to analyze the incidence and the factors associated with mortality related to RFCA. Ten of 4,651 cases (0.22%) reported to the Pediatric RFCA Registry resulting in death were reviewed and compared with a matched control group (n = 18). Death occurred in 5 of 4,092 children (0.12%, ages 0.1 to 13.3 years) with structurally normal hearts. Death was related to traumatic injury, myocardial perforation and hemopericardium, coronary or cerebral thromboembolism, and ventricular arrhythmia. All cases were left-sided (p = 0.019 vs right or septal) supraventricular arrhythmias with radiofrequency applications in the systemic atrium and/or ventricle, and all procedures were successful. Mortality occurred in 5 of 559 children (0.89%, p = 0.001 vs normals, ages 1.5 to 17.4 years) with structural heart disease. No new pathology except the mural radiofrequency lesions was seen at autopsy. Those with structurally normal hearts who died were smaller (32.7 vs 55.6 kg, p = 0.023) and had more radiofrequency applications (26.3 vs 8.7, p = 0.019) than those who survived. No differences were demonstrated for those with abnormal hearts. Operator experience was not different (deaths 103 +/- 106 vs controls 117 +/- 125, p = 0.41). Mortality associated with pediatric RFCA is rare, but is more frequent when there is underlying heart disease, lower patient weight, greater number of radiofrequency energy applications, and left-sided procedures. Operator experience does not appear to be a factor leading to mortality.
Collapse
Affiliation(s)
- M S Schaffer
- Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
| | | | | | | |
Collapse
|
27
|
Abstract
A 55-year-old woman with a history of resected atrial myxoma with residual patched atrial septal defect (ASD) underwent a successful radiofrequency (RF) ablation of reentry atrial tachycardia. She presented with progressive dyspnea 5 days later. Transesophageal echocardiography revealed a 1-cm right atrial mass attached to the intraatrial septum at the ablation site. Repeat study after anticoagulation for 5 weeks showed complete resolution of the thrombus. Thrombus formation at the site of RF ablation is a potential complication that may require aggressive anticoagulation. Patients with patched ASD might be at higher risk.
Collapse
Affiliation(s)
- A Farah
- Providence Hospital, Heart Institute, Southfield, Michigan 48075, USA
| | | | | |
Collapse
|
28
|
Nitta T, Ishii Y, Ogasawara H, Sakamoto S, Miyagi Y, Yamada K, Kanno S, Tanaka S. Initial experience with the radial incision approach for atrial fibrillation. Ann Thorac Surg 1999; 68:805-10; discussion 811. [PMID: 10509966 DOI: 10.1016/s0003-4975(99)00775-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgery for atrial fibrillation (AF) is performed with the aim of restoring sinus rhythm and atrial transport function, and preventing thromboembolism. The radial incision approach (RIA), in which the atrial incisions radiate from the sinus node toward the atrioventricular annular margins and parallel the coronary arteries, was developed as an outgrowth of and an alternative to the maze procedure in order to preserve a more physiological activation sequence and the atrial transport function. METHODS To determine whether the RIA is a promising procedure for AF, 23 patients who had undergone the RIA (n = 10) or the maze procedure (n = 13) for chronic AF associated with valvular heart disease were examined in terms of the postoperative cardiac rhythm and atrial transport function. RESULTS AF was cured in 90% of RIA patients and 92.3% of maze patients (not significant). One patient in each group required pacemaker implantation for an insufficient sinus rate postoperatively. The RIA was technically easier than the maze procedure, because the incisions were more linear and there was no isolation incision or "T-shape" incision in the left atrium. The left atrial transport function, assessed by transthoracic Doppler echocardiography, was greater after the RIA than after the maze procedure, while the right atrial transport function was equally preserved by both procedures. The peak atrial filling/early filling waves of the flow-velocity spectra across the mitral valve was significantly larger after the RIA than after the maze procedure (0.58+/-0.17 vs. 0.25+/-0.07, p<0.005). The left atrial filling fraction was significantly larger after the RIA than after the maze procedure (28.5%+/-5.0% vs. 15.1%+/-4.0%, p<0.001). CONCLUSIONS RIA provides a greater atrial transport function, and thus may represent a physiological alternative to the maze procedure as a surgical procedure for AF.
Collapse
Affiliation(s)
- T Nitta
- Department of Cardiothoracic Surgery, Nippon Medical School, Tokyo, Japan. nitta_takashi/
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Michelucci A, Antonucci E, Conti AA, Alessandrello Liotta A, Fedi S, Padeletti L, Porciani MC, Prisco D, Abbate R, Gensini GF. Electrophysiologic procedures and activation of the hemostatic system. Am Heart J 1999; 138:128-32. [PMID: 10385775 DOI: 10.1016/s0002-8703(99)70257-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thromboembolism occurs in 0.4% to 2% of the subjects undergoing radiofrequency ablation (RFA), but its mechanisms remain unclear. Our aim was to evaluate several parameters of the hemostatic system in relation to the electrophysiologic procedure. METHODS Thirty consecutive patients were enrolled in the study. Fifteen underwent electrophysiologic study and 15 underwent radiofrequency ablation. Before the ablation procedure, all subjects were given an intravenous heparin bolus (2500 IU). Blood samples were drawn immediately before, at the end of, and 24 hours after the procedures. Spontaneous platelet aggregation in whole blood and in platelet-rich plasma, markers of clotting activation (prothrombin fragment 1+2 and the thrombin-antithrombin complex) and the fibrinolytic system (plasminogen activator inhibitor and D-dimer) levels were evaluated. RESULTS At the end of the procedure, spontaneous platelet aggregation in whole blood, prothrombin fragment 1+2, thrombin-antithrombin complex, and D-dimer levels increased significantly in all patients. The hemostatic changes were more marked after RFA than after electrophysiology. Spontaneous aggregation in whole blood, prothrombin fragment 1+2, and thrombin-antithrombin complex levels at 24 hours after the procedure were similar to those observed before the procedure in both groups; D -dimer levels were still elevated with respect to preprocedure levels, with a trend toward higher levels in patients undergoing RFA rather than electrophysiology. A significantly more marked activation of coagulation (prothrombin fragment 1+2, P <.005) was found in patients in whom the mean duration of energy application was higher than 23.5 seconds. CONCLUSIONS Our data suggest that antithrombotic prevention with a prolonged administration of heparin and/or the association of antiplatelet agents should be considered in patients undergoing RFA.
Collapse
Affiliation(s)
- A Michelucci
- Istituto di Clinica Medica Generale e Cardiologia, Università di Firenze, Florence, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Anfinsen OG, Gjesdal K, Brosstad F, Orning OM, Aass H, Kongsgaard E, Amlie JP. The activation of platelet function, coagulation, and fibrinolysis during radiofrequency catheter ablation in heparinized patients. J Cardiovasc Electrophysiol 1999; 10:503-12. [PMID: 10355691 DOI: 10.1111/j.1540-8167.1999.tb00706.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Catheter ablation may be complicated by clinical thromboembolism in about 1% of patients. METHODS AND RESULTS We studied the activation of coagulation (prothrombin fragment 1+2 [PF1+2]), platelets (beta-thromboglobulin [beta-TG])) and fibrinolysis (plasmin-antiplasmin complexes [PAP] and D-dimer) during radiofrequency (RF) ablation in 13 patients. They received heparin 100 U/kg intravenously after the initial electrophysiologic study, prior to the delivery of RF current; thereafter 1,000 U/hour throughout the procedure. PF1+2 increased fourfold (P < 0.001) during the diagnostic study, but gradually declined to upper reference value during heparin administration. There was a strong correlation between procedure duration prior to heparin bolus (range 39 to 173 min); and (a) the maximal rise of PF1+2 (r = 0.83, P < 0.001) and (b) the increase of PF1+2 from baseline to end of the procedure (r = 0.74, P = 0.004). There was no correlation between postheparin changes of PF1+2 and (a) postheparin procedure duration (range 40 to 317 min), (b) number of RF pulses (range 1 to 16), or (c) RF current duration (range 46 to 687 sec). Plasma beta-TG concentration showed similar trends. Fibrinolytic activity increased moderately from baseline until heparin administration; then remained around the upper reference values. PAP at the end of procedure and D-dimer at the time of heparin administration both correlated with preheparin procedure duration (r = 0.70, P = 0.007 and r = 0.69, P = 0.01, respectively). All parameters were normal the next morning. CONCLUSION Procedure duration prior to heparin administration, and not the delivery of RF current per se, determines activation of hemostasis and fibrinolysis during RF ablation.
Collapse
Affiliation(s)
- O G Anfinsen
- Department of Cardiology, Rikshospitalet, University of Oslo, Norway.
| | | | | | | | | | | | | |
Collapse
|
31
|
Zhou L, Keane D, Reed G, Ruskin J. Thromboembolic complications of cardiac radiofrequency catheter ablation: a review of the reported incidence, pathogenesis and current research directions. J Cardiovasc Electrophysiol 1999; 10:611-20. [PMID: 10355704 DOI: 10.1111/j.1540-8167.1999.tb00719.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radiofrequency catheter ablation (RFCA) has become established as an effective therapy for the treatment of many cardiac tachyarrhythmias. The principle limitation of conventional RFCA continues to be the risk of thromboembolism. This risk is of particular concern for the ongoing development of the catheter maze procedure for the treatment of atrial fibrillation, which currently involves the creation of extensive linear lesions in the left atrium. METHODS AND RESULTS A Medline search of the literature over the last ten years was performed. Focused review of the reported thromboembolic complications of RFCA indicates an overall incidence of 0.6%. However, the risk is increased when ablation is performed in the left heart (1.8% to 2%) and for ventricular tachycardia (2.8%). It is of concern that intravenous heparin and the use of temperature feedback to control radiofrequency current do not eliminate the risk of thromboembolic events. CONCLUSION The thromboembolic complications of RFCA are not eliminated by the treatment of intravenous herapin and mode of temperature control during ablation. Potential approaches to further reduce the risk of thromboembolism include the adjunctive administration of specific inhibitors of platelet activation and aggregation, intraprocedural intracardiac echocardiography, irrigated radiofrequency ablation, and cryoablation catheter systems.
Collapse
Affiliation(s)
- L Zhou
- Cardiac Unit, Massachusetts General Hospital and Cardiovascular Biology Laboratory, Harvard School of Public Health, Boston 02114, USA
| | | | | | | |
Collapse
|
32
|
Ware DL, Boor P, Yang C, Gowda A, Grady JJ, Motamedi M. Slow intramural heating with diffused laser light: A unique method for deep myocardial coagulation. Circulation 1999; 99:1630-6. [PMID: 10096942 DOI: 10.1161/01.cir.99.12.1630] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catheter ablation of postinfarction ventricular tachycardia (VT) may be limited by insufficient myocardial coagulation or excessive endocardial or epicardial damage. We propose that volumetric heating restricted to intramural sites may improve the outcome and safety of this procedure, especially if delivered at rates that enhance heat conduction and forestall adverse tissue changes. METHODS AND RESULTS A novel optical fiber with a diffusing tip for direct intramural, volumetric laser heating was tested via thoracotomy and percutaneously in normal dogs. Low-power (2.0- to 4.5-W) diode laser light (805 nm) diffused within tissue induced large lesions but no visible surface damage, mural thrombi, or transmural perforation. Mean lesion depth approximated tip length (10 mm). Mean lesion widths in the thoracotomy and percutaneous groups were 5.8+/-0.5 to 9.1+/-0.84 mm and 5.2+/-0.85 to 7.9+/-1.1 mm, respectively, depending on the light dose. Mean volumes in the percutaneous group were 1006+/-245 to 2471+/-934 mm. ST-segment depression, appearing in unfiltered bipolar electrograms recorded from the guiding catheter, was specific for lesion induction. All dogs survived the protocol, which included a 1-hour observation period. In cross section, lesions were elliptical to spherical and characterized by extensive contraction-band necrosis abruptly bordering viable tissue. No platelets or fibrin adhered to the endocardium. CONCLUSIONS Slow, volumetric, and direct intramyocardial heating induces large, deep lesions without hazardous tissue damage. Such heating might cure postinfarction VT more successfully and safely than present techniques. Further testing and development of this method seem warranted.
Collapse
Affiliation(s)
- D L Ware
- Division of Cardiology of the Department of Internal Medicine, University of Texas Medical Branch, Galveston 77555-0553, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Manolis AS, Maounis T, Vassilikos V, Melita-Manolis H, Psarros L, Terzoglou G, Cokkinos DV. Pretreatment with antithrombotic agents during radiofrequency catheter ablation: a randomized comparison of aspirin versus ticlopidine. J Cardiovasc Electrophysiol 1998; 9:1144-51. [PMID: 9835257 DOI: 10.1111/j.1540-8167.1998.tb00085.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION D-dimer is a product of fibrin degradation and can serve as a biochemical marker of thrombus formation and reactive fibrinolysis. According to our previous observations, and as reflected by elevated plasma D-dimer levels, lesions produced by radiofrequency (RF) ablation have a thrombogenic effect. Pretreatment with combined aspirin and ticlopidine mitigates this thrombogenicity; however, the effect of either agent alone remains unknown. METHODS AND RESULTS In this study, 59 patients undergoing RF ablation were randomized to pretreatment with aspirin (group I; n = 30) or ticlopidine (group II; n = 29) for 3 days prior to RF ablation. D-dimer levels were measured by enzyme immunoassay before and after the electrophysiologic study (EPS), and both immediately and at 48 hours after RF ablation. Results also were compared with those of 31 patients (nonrandomized group III) who had received both aspirin and ticlopidine. At all stages, D-dimer levels were higher in groups I and II when compared with group III. Baseline D-dimer (31+/-20 vs 24+/-13 vs 17+/-11 microg/L, respectively; P = 0.002) rose after EPS to higher levels in groups I and II (91+/-100 microg/L and 51+/-35 microg/L) compared with group III (31+/-17 microg/L; P = 0.001). After RF ablation, D-dimer levels increased in all groups, but this increase was much higher in groups I and II (214+/-210 microg/L and 201+/-222 microg/L) than in group III (74+/-60 microg/L; P = 0.005). At 48 hours, D-dimer levels decreased in all groups, but remained higher in groups I and II (91+/-100 microg/L and 95+/-99 microg/L) than in group III (35+/-31 microg/L; P = 0.009). There were no differences among the three groups in the number of RF ablation lesions or the duration of the RF ablation procedure. CONCLUSION Pretreatment with aspirin or ticlopidine alone does not decrease the thrombogenic potential of RF ablation. Only combined therapy with aspirin and ticlopidine has a favorable effect, as reflected by the lower degree of D-dimer elevation.
Collapse
Affiliation(s)
- A S Manolis
- Onassis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | | | | |
Collapse
|
34
|
Dorbala S, Cohen AJ, Hutchinson LA, Menchavez-Tan E, Steinberg JS. Does radiofrequency ablation induce a prethrombotic state? Analysis of coagulation system activation and comparison to electrophysiologic study. J Cardiovasc Electrophysiol 1998; 9:1152-60. [PMID: 9835258 DOI: 10.1111/j.1540-8167.1998.tb00086.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although thromboembolism is an uncommon complication of radiofrequency (RF) ablation, some preliminary reports have suggested that RF ablation results in activation of the coagulation system, possibly increasing this risk. We hypothesized that the insertion of intravenous catheters and their prolonged intravenous placement rather than RF ablation activates the coagulation cascade. METHODS AND RESULTS Thirty-seven patients, group 1 (n = 21) during RF ablation, and group 2 (n = 16) during routine electrophysiologic studies (EPS), were studied prospectively. Blood was drawn for coagulation and fibrinolytic studies following insertion of venous sheaths (T0), following catheter placement (T1), and 1 hour after completion of RF ablation or EPS (T2). Conversion of prothrombin to thrombin was measured using thrombin-antithrombin complex (TAT) and prothrombin activation peptide (F1+2), and fibrinolytic activity was assessed using D-dimer concentration. Levels of D-dimer increased in group 1 from 823.52+/-323.52 ng/mL at T0 to 1,314.28+/-297.63 ng/mL at T2 (P = 0.005), and in group 2 from 658.15+/-161.70 ng/mL at T0 to 1625+/-641.45 ng/mL at T2 (P = 0.064). TAT levels increased from to 27.74+/-5.6 microg/L at T0 to 52.99+/-5.93 microg/L at T2 in group 1 (P = 0.09), and from 19.79+/-5.14 microg/L at T0 to 73.5+/-24.15 microg/L at T2 in group 2 (P = 0.05). F1+2 concentration increased from 1.52+/-0.30 nmol/L at T0 to 3.06+/-0.41 nmol/L at T2 in group 1 (P = 0.004), and from 1.32+/-0.30 nmol/L at T0 to 3.11+/-0.46 nmol/L at T2 in group 2 (P = 0.087). There was no significant difference in the concentration of the three coagulation variables between group 1 and group 2 at any given time point. No correlation was demonstrable between concentration of D-dimers, TAT, or F1+2 and variables of RF delivery such as cumulative energy, number of RF energy applications, or number of impedance rises. However, a significant positive correlation (r = 0.65, P<0.01) was noted between the duration of the RF ablation procedure and the concentration of D-dimers. CONCLUSION We conclude that activation of the coagulation cascade in RF ablation procedures is not related to the delivery of RF energy, but is related to the placement of intravascular catheters and to the duration of the ablation procedure.
Collapse
Affiliation(s)
- S Dorbala
- St. Luke's-Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, New York 10025, USA
| | | | | | | | | |
Collapse
|
35
|
Manolis AS, Vassilikos V, Maounis TN, Psarros L, Melita-Manolis H, Papatheou D, Haliassos A, Christopoulou-Cokkinou V, Cokkinos DV. Pretreatment with aspirin and ticlopidine confers lower thrombogenic potential of radiofrequency catheter ablation. Am J Cardiol 1997; 79:494-7. [PMID: 9052357 DOI: 10.1016/s0002-9149(96)00792-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In the present study we pretreated 31 patients undergoing radiofrequency catheter ablation (RFA) with combined aspirin and ticlopidine for 3 days before the procedure, whereas 37 patients did not receive pretreatment. D-dimer levels reflecting the thrombogenic potential of RFA were significantly lower in the pretreated group at each stage before, during, and after the procedure, whereas there were no significant differences between the 2 groups in the number of RFA lesions or duration of the procedure.
Collapse
Affiliation(s)
- A S Manolis
- Onossis Cardiac Surgery Center, Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|