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

Abstract

IntroductionMyocardial 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.MethodsConsecutive 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.Results96 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).ConclusionHs-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.

Comparison of myocardial injury and inflammation after pulmonary vein isolation for paroxysmal atrial fibrillation between radiofrequency catheter ablation and cryoballoon ablation

“…Recently Zeljkovic et al 21 reported there was no significant difference in troponin release between patients treated with radiofrequency catheter ablation and cryoballoon ablation. None of the myocardial injury markers were predictive for AF recurrence.…”

Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy

“…Transthoracic and transoesophageal echocardiogram to rule out left atrial (LA) thrombus, to determine LA diameter in the parasternal long axis (PLAX) plane, and left ventricular ejection fraction (LVEF) were performed before every PVI procedure. PVI procedure was performedeither using: (i) focal irrigated‐tip radiofrequency (RF) catheter (RF‐group) in combination with a 3D electroanatomical mapping systems (either CARTO3, Biosense Webster, or NavX, Abbott) as described in detail previously 13 , 14 ; (ii) using the 2nd‐generation cryoballoon (Arctic Front Advance 28 mm Medtronic Inc.,) ablation (CB‐group) as described in detail previously. 13 , 14 …”

“…PVI procedure was performedeither using: (i) focal irrigated‐tip radiofrequency (RF) catheter (RF‐group) in combination with a 3D electroanatomical mapping systems (either CARTO3, Biosense Webster, or NavX, Abbott) as described in detail previously 13 , 14 ; (ii) using the 2nd‐generation cryoballoon (Arctic Front Advance 28 mm Medtronic Inc.,) ablation (CB‐group) as described in detail previously. 13 , 14 …”

Longer diagnosis‐to‐ablation time is associated with recurrence of atrial fibrillation after catheter ablation—Systematic review and meta‐analysis

“…3 Nevertheless, effort to predict the recurrence of AF is an exciting development. [4][5][6][7] It enables physicians to stratify the risk of AF recurrence and weight the risk and benefit on the patients before performing catheter ablation.…”