Association between left atrial low-voltage area, serum apoptosis, and fibrosis biomarkers and incidence of silent cerebral events after catheter ablation of atrial fibrillation

Müller, Patrick; Maier, Johannes; Dietrich, Johannes W.; Barth, Sebastian; Griese, Daniel P.; Schiedat, Fabian; Szöllősi, Attila Gábor; Halbfaß, Philipp; Nentwich, Karin; Roos, Markus; Krug, Joachim; Schade, Anja; Schmitt, Rainer; Mügge, Andreas; Deneke, Thomas

doi:10.1007/s10840-015-0020-6

Cited by 13 publications

(12 citation statements)

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“…All patients underwent RFA with effective anticoagulation. Previous studies have established the association of CHADS 2 /CHA 2 DS 2 VASc scores with the occurrence of cerebrovascular accident during IPV, 7 , 17 but several studies showed no relationship between these scores and procedure-related thromboembolism. 4 , 18 – 20 …”

Section: Discussionmentioning

confidence: 99%

“… 3 Additionally, periprocedural diffusion-weighted cerebral magnetic resonance imaging (DW-MRI) has shown that the IPV procedure can lead to subclinical cerebral embolism in up to 48% of patients. 4 – 8 Previous studies have been performed to evaluate silent cerebral lesions during IPV using DW-MRI as a reference diagnostic method. However, another study suggested that DW-MRI lacks sensitivity, and the authors investigated whether detection of cerebral damage during IPV can be improved by assessing a sensitive biomarker of neuronal injury: protein S100B.…”

Section: Introductionmentioning

confidence: 99%

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Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation

et al. 2018

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ObjectiveCatheter ablation of atrial fibrillation (AF) can lead to thromboembolic complications, especially stroke. We measured the periprocedural serum neuron-specific enolase (NSE) level, which is a biomarker of neuronal injury, after ablation of AF.MethodsForty-three patients with paroxysmal AF were prospectively enrolled before radiofrequency ablation. A neurological examination was performed before and after the procedure. The serum NSE level was determined before and at the end of the procedure and at 2, 24, and 48 h after the procedure.ResultsNo patients developed new neurological deficits. However, the median (interquartile range) NSE level increased after ablation from 6.7 (3.87) ng/mL at baseline to 11.48 (5.3) ng/mL at 24 h postoperatively. The NSE level exceed the upper reference limit of normal (17 ng/mL) in 14 patients (33%), and these patients were found to have a larger left atrium.ConclusionsSerum NSE increased in most of the patients undergoing ablation for AF, and it exceeded the normal limit in one-third of the patients. Although NSE is a biomarker of neuronal injury, the clinical importance of this increase after AF ablation and its relationship with the left atrial diameter should be evaluated in a longitudinal study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation

et al. 2018

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“…Ancak bu prosedürün en önemli komplikasyonlarından biri, hastaların %1'inde görüle-bilen serebrovasküler olaylardır (3). Hatta difüzyon manyetik rezonans görüntüleme (MRG) ile değerlendirild-iğinde; subklinik serebral emboli sıklığının %48'e kadar yükseldiğini gösteren çalışmalar mevcuttur (4)(5)(6)(7). Bu çalışmalarda AF ablasyonu ilişkili serebral komplikasyonlar difüzyon MRG ile değerlendirilmiştir.…”

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Atriyal fibrilasyon kateter ablasyonu yapılan hastalarda serum nöron spesifik enolaz düzeylerindeki değișim

Acibuca¹

2017

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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Amaç: Atriyal fibrilasyon (AF) kateter ablasyonu, antiaritmik tedaviye rağmen semptomatik olan hastalar için uygun bir tedavi seçeneğidir. Ancak bu ișlem, bașta inme olmak üzere tromboembolik komplikasyonlara yol açabilmektedir. Biz, ablasyon ișlemi sırasında ve sonrasında, akut nöronal hasarın biyomarkerı olarak bilinen serum nöron spesifik enolaz (NSE) düzeylerindeki değișimi ölçmeyi amaçladık.Gereç ve Yöntem: Paroksismal AF'si olan 43 hastaya radyofrekans ablasyon yöntemi ile pulmoner ven izolasyonu yapıldı. İșlem öncesi ve sonrasında karșılaștırmalı olarak nörolojik muayeneleri yapılan hastaların serum NSE düzeyleri; ișlemden hemen önce, ișlemin sonunda, ișlem bittikten 2 saat, 24 saat ve 48 saat sonrasında ölçülerek değerlendirildi.Bulgular: Hastaların hiçbirinde yeni gelișen nörolojik defisit izlenmedi. Ama NSE seviyeleri 14 hastada üst referans limit olan 17 ng/ml'nin üzerine çıktı ve 33 hastada bazal seviyesine göre %50 artıș gösterdi. Yaș, hipertansiyon, geçirilmiș inme, diyabet, aterosklerotik kalp hastalığı varlığı, CHA2DS2 VASc skoru [birleșik risk skoru [her biri 1 puan]: konjestif kalp yetmezliği, hipertansiyon, 75 yaș ve üstü (2 puan), diyabet, inme (2 puan), 65 yaș ve üstü, vasküler hastalık, kadın cinsiyet] gibi klinik parametreler ve aktive pıhtılașma zamanı, toplam ișlem süresi, elektriksel kardiyoversiyon gibi ișlem ilișkili parametreler NSE seviyesinde artıșla ilișkili bulunmadı. Ama, NSE seviyesi üst referans limitin üstüne yükselen hastaların sol atriyum çap-ları daha geniști ve NSE seviyesinde %50 artıș izlenen hastaların ișlem sırasındaki sistolik kan basıncı değerleri daha düșüktü.Sonuç: Serum NSE seviyeleri AF ablasyonu yapılan hastaların büyük kısmında artıș göstermiș ve üçte birinde normalin üst sınırını așmıștır. Serum NSE düzeylerindeki artıș nöronal hasarın bir belirteci olarak kabul edilse de AF ablasyonu yapılan hastalarda izlenen bu artıșın serebral embolilerle ilișkisini ortaya koymak için daha ileri çalıșmalara gerek vardır.Anahtar Sözcükler: Atriyal Fibrilasyon, Pulmoner Ven Izolasyonu, Radyofrekans Ablasyon, Serum Nöron Spesifik Enolaz Aim: Catheter ablation of atrial fibrillation (AF) is a favourable therapeutic option for the treatment of patients, who are symptomatic despite antiarrhythmic medication. However, this procedure may lead to thromboembolic complications, especially stroke. We aimed to measure serum neuron-specific enolase (NSE) levels, which is known as biomarker of acute neuronal injury, during and after the ablation. Materials and Methods:Forty three patients with paroxysmal AF underwent pulmonary vein isolation performed by radiofrequency ablation. A neurological examination was performed pre-and postprocedural period. Serum NSE levels were determined before and at the end of the procedure, at 2, 24 and 48 hours after the procedure.Results: None of the patients developed new neurological deficits. But NSE levels increased after ablation above the upper reference limit of 17 ng/ml in 14 patients; and also 50% increase was observed compared to baseline in 33...

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“…We agree that stroke in atrial fibrillation (AF) appears to be a complex and poorly understood phenomenon. A number of recent studies have demonstrated an association between left atrial electrical remodeling and thrombogenesis [3][4][5][6] suggesting that the underlying left atrial substrate may be an important determinant of stroke risk and that adverse atrial remodeling could convey an increased risk even in the absence of AF itself.…”

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confidence: 99%

Response to letter: ‘Bear tracks hypothesis: from atrial fibrillation to atrial fibrosis syndrome in stroke risk assessment’

O’Neill

Harrison

O’Neill

et al. 2017

Expert Review of Cardiovascular Therapy

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Association between left atrial low-voltage area, serum apoptosis, and fibrosis biomarkers and incidence of silent cerebral events after catheter ablation of atrial fibrillation

Abstract: LA remodeling, estimated by LADmax and LA low-voltage area, has significant relationship with the risk of SCE after AF ablation. Moreover, Fas-Ligand may act as an independent predictor for SCE in the context of AF CA.

Cited by 13 publications

References 28 publications

Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation

Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation

Atriyal fibrilasyon kateter ablasyonu yapılan hastalarda serum nöron spesifik enolaz düzeylerindeki değișim

Response to letter: ‘Bear tracks hypothesis: from atrial fibrillation to atrial fibrosis syndrome in stroke risk assessment’

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