Time Course of Inflammation, Myocardial Injury, and Prothrombotic Response After Radiofrequency Catheter Ablation for Atrial Fibrillation

Abstract

Ninety consecutive patients undergoing elective RF catheter ablation for AF were prospectively studied. All patients >18 years old, with a © 2014 American Heart Association, Inc. Original ArticleBackground-Inflammation has been linked to the genesis of stroke in atrial fibrillation (AF) and is implicated in early recurrent arrhythmia after AF ablation. We aimed to define the time course of inflammation, myocardial injury, and prothrombotic markers after radiofrequency ablation for AF and its relation to AF recurrence. Methods and Results-Ninety consecutive AF patients (53% paroxysmal) undergoing radiofrequency ablation were recruited. High-sensitivity C-reactive protein (hs-CRP), Troponin-T, creatine kinase-MB, fibrinogen, and D-Dimer concentrations were measured at baseline, at 1, 2, 3, 7 days, and at 1 month after ablation. AF recurrence was documented at 3 days and at 1, 3, and 6 months follow-up. Troponin-T and creatine kinase-MB peaked at day 1 after procedure (both P<0.05). Hs-CRP peaked at day 3 after procedure (P<0.05). Fibrinogen (P<0.05) and D-Dimer (P<0.05) concentrations were significantly elevated at 1 week after procedure. Ln hs-CRP elevation correlated with Ln Troponin-T and fibrinogen elevation. The extent of Ln hs-CRP, Ln Troponin-T, and fibrinogen elevation predicted early AF recurrence within 3 days after procedure (P<0.05, respectively), but not at 3 and 6 months. Conclusions-Patients undergoing radiofrequency ablation for AF exhibit an inflammatory response within 3 days. The extent of inflammatory response predicts early AF recurrence but not late recurrence. Prothrombotic markers are elevated at 1 week after ablation and may contribute to increased risk of early thrombotic events after AF ablation. (Circ Arrhythm Electrophysiol. 2014;7:83-89.)

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies – Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

“…4 Lim et al reported that an elevation of inflammatory markers predicted recurrent arrhythmias within 3 days of the procedure, but not at 3 and 6 months. 6 Those findings support the hypothesis that inflammation plays a prominent role in the etiology of ERAF after RF ablation. From this standpoint, the incidence and significance of ERAF may differ between RF and CB ablation.…”

“…25 Relatively lower hs-CRP levels might be related to the lack of endothelial damage with cryoablation, whereas the freeze/thaw process with cardiomyocyte swelling and membrane rupture might induce greater release of myocardial injury markers. Prior studies speculated that the inflammatory response could be partly explained by local myocardial injury in RF ablation because of the positive correlation between hs-CRP elevation and markers of myocardial injury, 6 but according to our study results that did not seem applicable to CB ablation.…”

“…[4][5][6] The aim of the present study was to prospectively compare (1) the proportion of patients with AF recurrence within the first 3 months post ablation procedure (ie, ERAF) using a 14-day consecutive monitoring system, (2) the timecourse patterns of biomarkers of myocardial injury, and inflammatory and prothrombotic biomarkers during the perioperative period, and (3) the factors associated with ERAF, in RF and 2nd-generation CB ablation patients with paroxysmal AF.…”

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

“…Interruption or reduction of blood flow between cryoballoon and myocardial tissue due to improved contact force by cryoballoon might have led to lower temperatures. Improved contact of cryobal- [14] has shown that post-ablation TnT levels were associated with early AF recurrence occurring within the first three days after ablation whereas there was no association with AF recurrence in three and six months. Casella et al [6] found no association between post-CA levels of CK-MB and TnI with AF recurrence during the follow-up visits at one, three, six, and 12 months.…”

Recurrence of Atrial Tachyarrhythmia During the Second Month of the Blanking Period Is Associated With More Extensive Pulmonary Vein Reconnection at Repeat Electrophysiology Study

“…Recent biochemical data have shown that the postablation inflammatory phase is usually limited to the first month after PVI, 12 and a study of heart rate variability changes has also demonstrated the spontaneous recovery of transient autonomic dysfunction by 1 month. 7 Histological studies have described the formation of well-demarcated homogenous lesions by 1 week after ablation.…”