Macaluso G, Comet B, Bouvier J L, Berrouba A, Barragan P, Commeau P, Roquebert P O
Centre hospitalier Beauregard, 12, impasse du Lido, 13425 Marseille.
Arch Mal Coeur Vaiss. 2002 Feb;95(2):102-8.
Creatinine phosphokinase and its MB iso-enzyme do not allow assessment of the degree of tissue necrosis after radiofrequency ablation. Cardiac Troponin I and myoglobin, new markers of myocardial lesions, are rarely used in this indication. The aim of this prospective study was to measure and compare serum markers of myocardial damage after high energy radiofrequency ablation of atrial flutter with an 8 mm distal electrode catheter. The authors measured serum cardiac Troponin I, myoglobin, creatinine phosphokinase and its MB iso-enzyme levels before and 4, 12 and 24 hours after radiofrequency ablation of common atrial flutter in 23 consecutive patients. The same markers were also measured in a control group of 9 patients undergoing electrophysiological investigation without radiofrequency ablation. All ablation procedures were simple with an average of 12.6 +/- 6 applications of radiofrequency. Bidirectional isthmic block was obtained in 22 of the 23 patients. The mean Troponin I levels were 0.01 microgram/l before ablation, 0.87 +/- 0.77 at the 4th hour (p < 0.001 versus control), 1.16 +/- 1.2 at the 12th hour (p < 0.001 versus control) and 0.7 +/- 0.63 microgram/l at the 24th hour (p < 001 versus control) after ablation. Only 13% of patients had cardiac troponin levels greater than the threshold of significant myocardial damage (> 2 micrograms/l) with a higher average number of radiofrequency applications than the rest of the group: 15.2 +/- 1 versus 11.5 +/- 5.1 (p < 0.05). An abnormally high level of markers was found in the ablation group for 19 patients (84%) with Troponin I (> 0.4 microgram/l), for 10 patients (43%) with the MB iso-enzyme (> 8 Ul/L), and for 1 patient (4%) with myoglobin (> 90 micrograms/l), and in no patient for creatinine phosphokinase (> 290 IU/L). All values were normal in the control group. The authors conclude that cardiac Troponin I is the most sensitive marker for myocardial cellular damage after high energy radiofrequency ablation of atrial flutter. The level of cardiac Troponin I seems to correlate with the number of applications of radiofrequency.
肌酸磷酸激酶及其MB同工酶无法用于评估射频消融术后组织坏死的程度。心肌损伤的新标志物心肌肌钙蛋白I和肌红蛋白，在此适应症中很少使用。这项前瞻性研究的目的是测量和比较使用8毫米远端电极导管对心房扑动进行高能射频消融术后心肌损伤的血清标志物。作者测量了23例连续患者在射频消融普通心房扑动前以及消融后4小时、12小时和24小时的血清心肌肌钙蛋白I、肌红蛋白、肌酸磷酸激酶及其MB同工酶水平。在9例接受电生理检查但未进行射频消融的患者组成的对照组中也测量了相同的标志物。所有消融操作均简单，平均进行12.6±6次射频应用。23例患者中有22例获得双向峡部阻滞。消融前肌钙蛋白I平均水平为0.01微克/升，消融后第4小时为0.87±0.77微克/升（与对照组相比，p<0.001），第12小时为1.16±1.2微克/升（与对照组相比，p<0.001），第24小时为0.7±0.63微克/升（与对照组相比，p<0.001）。只有13%的患者心肌肌钙蛋白水平高于显著心肌损伤阈值（>2微克/升），其平均射频应用次数高于该组其他患者：15.2±1次对11.5±5.1次（p<0.05）。在消融组中，19例患者（84%）的肌钙蛋白I（>0.4微克/升）、10例患者（43%）的MB同工酶（>8 Ul/L）和1例患者（4%）的肌红蛋白（>90微克/升）出现异常高水平，而肌酸磷酸激酶（>290 IU/L）在任何患者中均未出现异常。对照组所有值均正常。作者得出结论，心肌肌钙蛋白I是心房扑动高能射频消融术后心肌细胞损伤最敏感的标志物。心肌肌钙蛋白I水平似乎与射频应用次数相关。
