Intracardiac Hemostasis and Fibrinolysis Parameters in Patients with Atrial Fibrillation

Abstract

Aims To identify intracardiac hemostasis or fibrinolysis abnormalities, which are associated with atrial fibrillation (AF) and increase the risk of thromboembolism. Patients and Methods Patient group consisted of 24 patients with AF and control group included 14 individuals with other supraventricular tachycardia undergoing transcatheter radiofrequency ablation. Blood samples were drawn from the femoral vein (FV), left atrium (LA), and left atrial appendage (LAA) before the ablation procedure. Fibrinogen, factor VIII (FVIII) and factor XIII activity, von Willebrand factor (VWF) antigen, thrombin-antithrombin (TAT) complex, quantitative fibrin monomer (FM), plasminogen, α2-plasmin inhibitor, plasmin-α2-antiplasmin (PAP) complex, PAI-1 activity, and D-dimer were measured from all samples. Results Levels of FVIII and VWF were significantly elevated in the FV and LA of AF patients as compared to controls. TAT complex, FM, PAP complex, and D-dimer levels were significantly elevated in the LA as compared to FV samples in case of both groups, indicating a temporary thrombotic risk associated with the catheterization procedure. Conclusions None of the investigated hemostasis or fibrinolysis parameters showed significant intracardiac alterations in AF patients as compared to non-AF controls. AF patients have elevated FVIII and VWF levels, most likely due to endothelial damage, presenting at both intracardiac and systemic level.

Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques

“…Previously, our group measured hemostasis activation in blood samples obtained sequentially from different sites including the femoral vein, the left atrium, and the left atrial appendage without any ablation therapy. In this earlier work, which was completed in a different patient cohort than the present study, we demonstrated that transseptal puncture itself is a significant signal for further hemostasis activation [13]. e main focus of the present study was to evaluate the effect of left atrial ablation per se; therefore, blood samples were obtained from the LA before the 1st and immediately after the last energy application.…”

“…Postablation blood samples were collected through the LA sheath after removal of the ablation catheter once the last ablation was finished. Forty-five ml blood samples were drawn from which the first 15 ml of blood was discarded in order to exclude intrasheath hemostasis activation [13]. Blood samples were collected into vacutainer tubes (tubes containing 0.109 M sodium citrate), tubes containing CTAD (buffered citrate, theophylline, adenosine, and dipyridamole), and tubes containing no anticoagulant (serum tubes with polymer gel separator, SST; Becton Dickinson, Franklin Lakes, NJ).…”

“…Previously, our group compared hemostasis markers in blood samples obtained from the femoral vein, from the left atrium, and from the left atrial appendage in patients with AF versus in those undergoing left atrial catheterization for another substrate. e aim of this earlier work was to explore potential site-specific differences in coagulation activation as well as the differences in patients with versus without AF [13]. Herein, we measured the levels of different fibrinolytic and endothelial activation markers in left atrial blood samples before and after PVI to assess to effect of the ablation per se.…”

Soluble Fibrin Monomer Complex and Prediction of Cardiovascular Events in Atrial Fibrillation: The Observational Murcia Atrial Fibrillation Project

“…In a recent study investigating intracardiac hemostasis or fibrinolysis abnormalities in AF patients, the SFMC levels did not show significant changes compared with controls. 31 In another study in patients with AF taking warfarin therapy, elevated SFMC levels during anticoagulant treatment were not useful as predictors of thromboembolic events. 32 To our knowledge, this is the first large real-world study investigating the role of SFMC for risk stratification and prediction of adverse cardiovascular events and mortality in AF patients receiving VKA therapy.…”

Uninterrupted Dabigatran Administration Provides Greater Inhibition against Intracardiac Activation of Hemostasis as Compared to Vitamin K Antagonists during Cryoballoon Catheter Ablation of Atrial Fibrillation

“…On the contrary, uninterrupted administration of dabigatran in randomized trials [17,18] was associated with significantly less bleeding complications as compared with continuous VKA administration. Recent studies suggest that in AF patients, intracardiac blood sampling revealing local conditions of hemostasis activation and endothelial damage might reflect the thrombogenic state more precisely, as blood sampling from the systemic circulation might not be able to show subtle, but significant local changes [19][20][21][22]. However, potential differences between various OACs to inhibit hemostasis activation in the settings of left atrial ablation, most probably due to the difficulty of intracardiac sampling, have not been directly tested from intracardiac blood samples as of yet.…”