不同技术心房颤动消融相关的心内纤维蛋白溶解与内皮激活
Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques.
作者信息
Hajas Orsolya, Bagoly Zsuzsa, Tóth Noémi K, Urbancsek Réka, Kiss Alexandra, Kovács Kitti B, Sarkady Ferenc, Nagy Attila, Oláh Anna V, Nagy László, Clemens Marcell, Csiba László, Csanádi Zoltán
机构信息
Institute of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Division of Clinical Laboratory Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
出版信息
Cardiol Res Pract. 2020 Feb 12;2020:1570483. doi: 10.1155/2020/1570483. eCollection 2020.
OBJECTIVE
The effect of pulmonary vein isolation (PVI) on fibrinolytic and endothelial activation with currently applied periprocedural anticoagulation has not been explored. We measured markers of fibrinolysis and endothelium activation before and after PVI with the second-generation cryoballoon (Cryo), pulmonary vein ablation catheter (PVAC-Gold), and irrigated radiofrequency (IRF).
METHODS
Markers of fibrinolysis and endothelium activation in left atrial (LA) blood samples were measured in 31 patients before and after PVI (Cryo:10, PVAC-Gold: 7, IRF: 14). Periprocedural anticoagulation included uninterrupted vitamin K antagonist and iv heparin (ACT≥300 sec) during LA dwelling.
RESULTS
Levels of (median; interquartile range, mgFEU/L) increased with all techniques (PVAC: 0.34; 0.24-0.50 versus 0.70; 0.61-1.31; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; (ng/ml) increased after Cryo (247.3, 199.9-331.6 versus 270.9, 227.9-346.7; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; (%) decreased with the PVAC (1.931; 0.508-3.859 versus 0.735, 0.240-2.707; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; and increased after PVI with all the 3 techniques. The levels of (ng/ml) did not change after PVAC procedures, but increased after Cryo (542, 6; 428.5-753.1 versus 619.2; 499.8-799.0; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93; =0.0313, Cryo: 0.33; 0.28-0.49 versus 0.79; 0.65-0.93.
CONCLUSION
PVI with contemporary ablation techniques and periprocedural antithrombotic treatment induces coagulation and endothelium activation of similar magnitude with different ablation methods.
目的
目前围手术期抗凝治疗下，肺静脉隔离（PVI）对纤溶和内皮激活的影响尚未得到研究。我们使用第二代冷冻球囊（Cryo）、肺静脉消融导管（PVAC-Gold）和灌注射频（IRF）测量了PVI前后的纤溶和内皮激活标志物。
方法
在31例患者的PVI前后（Cryo组10例、PVAC-Gold组7例、IRF组14例）测量左心房（LA）血样中的纤溶和内皮激活标志物。围手术期抗凝包括在LA停留期间不间断使用维生素K拮抗剂和静脉注射肝素（活化凝血时间[ACT]≥300秒）。
结果
所有技术下，（中位数；四分位间距，mgFEU/L）均升高（PVAC组：0.34；0.24 - 0.50对比于0.70；0.61 - 1.31；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；（ng/ml）在Cryo术后升高（247.3，199.9 - 331.6对比于270.9，227.9 - 346.7；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；（%）在PVAC术后降低（1.931；0.508 - 3.859对比于0.735，0.240 - 2.707；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；且所有3种技术的PVI术后和均升高。（ng/ml）水平在PVAC术后未改变，但在Cryo术后升高（542，6；428.5 - 753.1对比于619.2；499.8 - 799.0；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93；P = 0.0313，Cryo组：0.33；0.28 - 0.49对比于0.79；0.65 - 0.93。
结论
采用当代消融技术和围手术期抗栓治疗的PVI，不同消融方法引起的凝血和内皮激活程度相似。
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