Casella Michela, Dello Russo Antonio, Russo Eleonora, Al-Mohani Ghaliah, Santangeli Pasquale, Riva Stefania, Fassini Gaetano, Moltrasio Massimo, Innocenti Ester, Colombo Daniele, Bologna Fabrizio, Izzo Gennaro, Gallinghouse Joseph G, Di Biase Luigi, Natale Andrea, Tondo Claudio
Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Milan , Italy.
Cardiol J. 2014;21(5):516-23. doi: 10.5603/CJ.a2013.0153. Epub 2013 Dec 2.
Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies.
One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 ± 3 h and 43 ± 3 h after ablation. At the first postprocedural sample, cTnI and CK-MB levels were found elevated in all 110 patients with a median value of 2.11 ng/mL and 8.95 ng/mL, respectively. Group B showed cTnI levels increased (median 5.96 ng/mL) compared to other groups (median Group A: 1.72 ng/mL, Group C: 1.54 ng/mL, Group D: 2.0 ng/mL; p < 0.001). Also CK-MB levels resulted higher in cryoablation (median 26.4 ng/mL) compared to other groups (median Group A: 6.40 ng/mL, Group C: 7.15 ng/mL, Group D: 6.50 ng/mL; p < 0.001). No significant association was observed between biomarker levels and recurrences of atrial fibrillation after a mean follow-up of 369 ± 196 days.
Highest markers for myocardial injury were observed in the cryoballoon group. It is possible that a longer delivery energy duration and other factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown.
我们的研究旨在比较采用不同技术进行心房颤动消融术后急性心肌损伤生物标志物的升高情况。
110例患者采用4种不同技术进行肺静脉隔离：35例患者使用开放式灌注尖端射频（RF）导管（A组），35例患者使用冷冻球囊（B组），20例患者使用视觉引导激光球囊（C组），20例患者使用具有接触力传感技术的开放式灌注尖端RF导管（D组）。消融术后19±3小时和43±3小时采集心肌肌钙蛋白I（cTnI）和肌酸激酶同工酶MB（CK-MB）的术后样本。在术后第一个样本中，110例患者的cTnI和CK-MB水平均升高，中位数分别为2.11 ng/mL和8.95 ng/mL。与其他组相比，B组cTnI水平升高（中位数5.96 ng/mL）（A组中位数：1.72 ng/mL，C组中位数：1.54 ng/mL，D组中位数：2.0 ng/mL；p<0.001）。与其他组相比，冷冻消融的CK-MB水平也更高（中位数26.4 ng/mL）（A组中位数：6.40 ng/mL，C组中位数：7.15 ng/mL，D组中位数：6.50 ng/mL；p<0.001）。平均随访369±196天后，未观察到生物标志物水平与心房颤动复发之间存在显著关联。
冷冻球囊组观察到最高的心肌损伤标志物。可能是更长的能量输送持续时间和其他影响损伤大小的因素导致冷冻消融中更高程度的心脏损伤。心脏生物标志物的较高水平并未转化为更好的结果，其生理意义尚不清楚。
