Blood damage, platelet and clotting activation during application of radiofrequency or cryoablation catheters: a comparative in vitro study

Abstract

During catheter ablation of cardiac tissue, the insulting stimulus may damage and activate the blood. Specifically activation of platelets and the clotting system is a potential risk by their formation of thrombi. In this study the effect of two different techniques, a radiofrequency and a cryo-application procedure, on the activation of platelets and clotting in an in vitro blood circulation model was investigated. The radio-frequency procedure induced significantly more blood cell damage, platelet activation and clotting than did the cryo-application procedure. Macroparticles were circulating in blood after the radiofrequency procedure. In the cryo procedure, blood damage was limited to the frozen blood spherule around the tip of the catheter. It is concluded that at least in those circumstances where blood is directly contacting the tip of the radiofrequency or cryo-application catheter, the latter is more safe with regard to thrombus formation.

Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach

“…The nature of emboli recorded during energy application (66% of the total number of cerebral MESs), and manipulation between the applications in the ENDO PVI (26% of the total cerebral MESs), are not completely understood. Both thrombi [15,18] as gaseous formation [16,17] could occur in both phases. Lickfett et al [6] demonstrated with diffusionweighted (DW)-MRI that 10% of the patients treated by a percutaneous endocardial ablation method had cerebral embolic lesions post-procedurally.…”

“…In this study, 332 (AE193) cerebral MES were detected prior to the first energy application, which represents 8% of all the MES detected during the whole ENDO procedure, as shown in Table 2. When applying ablation energy on the endocardial wall of the ostia of the PV, the cardiac endothelium is damaged; this may lead to platelet adhesion and activation, thus resulting in clot formation [15]. Another cause of emboli during the applications could be linked to high temperatures.…”

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…An in vitro study demonstrated significant damage to blood cells and platelets with RFCA compared with catheter cryoablation. 550 A comparison of catheter cryoablation with RFCA in 30 adult patients has been reported by Tse et al 551 They found a significant increase in platelet activation in the RFCA group compared with the catheter cryoablation group. Several thrombotic parameters were elevated in both the catheter cryoablation and RFCA groups, observed immediately after sheath insertion.…”

Hemostatic changes before and during electrophysiologic study and radiofrequency catheter ablation

“…Because the number of thromboembolic complications of RFA is low, identification of the risk factors is difficult and the significance of the pathophysiological mechanisms of hemostasis activation during RFA has not been definitively established in studies published to date. T0 before insertion of sheaths, T1 end of EPS, T2 30 min after completion of RFA, DD D-dimers, TAT thrombin-antithrombin III, PAI-1 plasminogen activator inhibitor type 1, t-PA tissue-type plasminogen activator, CPAi circulating platelet aggregates index, LCL lower confidence level, UCL upper confidence level Potential mechanisms of thrombogenesis during ablation procedures are multiple and include endothelial disruption, coagulation necrosis, electroporation injury, mechanical damage of the vessel wall, and heating of circulating blood elements by RF energy [9][10][11][12][13][14][15][16][17][18]. Sasano et al [19] concluded that the thrombogenesis caused by RFA has 2 phases; in the acute phase hemostasis activation occurs during placement of the catheters and in the delayed phase thrombogenesis is the result of endothelial damage caused by the RF current.…”