Limitations of biomarkers serum levels during pulmonary vein isolation.
OBJECTIVE
Several biomarkers have been used for evaluation and quantification of myocardial injury after effective ablation. We studied possible different thermal stability and usability of the proteins released by cardiac cells injured by different energy sources.


METHODS
Firstly, we tested in vitro thermal stability of creatinine kinase (CK), myocardial bound creatinine kinase (CKMB), cardiac troponins I (cTnI) and cardiac troponins T (cTnT) in collected blood samples from 15 patients (pts) with confirmed ST-segment elevated myocardial infarction (STEMI). Secondly, the biomarkers were collected and analyzed in 82 pts treated with radiofrequency ablation (RFA) and in 79 pts treated with cryo-balloon ablation (CBA).


RESULTS
In vitro experiment showed that all biomarkers were stable in low temperature of -30(o)C. Troponins were stable in the high temperatures analyzed. A substantial drop in CK and CKMB levels were measured at 50°C and 40° C, respectively. In vivo study showed that the increase in CKMB levels was highly significant in CBA pts only. Pathological CKMB values were observed in 24% of RFA pts and 98% of CBA pts. Pathological cTnI values were observed in all pts and the rise in cTnI levels was highly significant in both groups after ablation.


CONCLUSIONS
Both in vitro and in vivo results show that CKMB cannot be used for quantitative determination of myocardial injury produced by radiofrequency energy. Only cardiac troponins reflect myocardial injury, regardless of energy source, and may be considered in future studies for comparison of biomarkers effects of cryo versus radiofrequency ablation.
Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. m.wojcik@am.lublin.pl
Maciej
M
Wojcik
Sebastien
S
Janin
Malte
M
Kuniss
Alexander
A
Berkowitsch
Damir
D
Erkapic
Sergey
S
Zaltsberg
Katherina
K
Madlener
Andrzej
A
Wysokinski
Christian W
CW
Hamm
Heinz F
HF
Pitschnera
Thomas
T
Neumann
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000032:analysis*; D017115:Catheter Ablation / Q000009:adverse effects*; D003452:Cryosurgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D011489:Protein Denaturation; D011667:Pulmonary Veins / Q000502:physiology* / Q000601:surgery*; D013696:Temperature
D015415:Biomarkers