Comparison of effects on coagulation and inflammatory markers using a duty-cycled bipolar and unipolar radiofrequency pulmonary vein ablation catheter vs. a cryoballoon catheter for pulmonary vein isolation.
OBJECTIVE
Thrombo-embolic events are one of the most feared complications related to atrial fibrillation (AF) ablation. Since radiofrequency (RF) energy is thought to be associated with a higher risk of thrombus formation than cryoenergy, the purpose of this study was to assess if the degree of activation of coagulation and inflammatory markers differed between ablation procedures performed with a cryoballoon catheter vs. a RF energy-based pulmonary vein ablation catheter (PVAC), respectively.


RESULTS
Thirty patients referred for AF ablation were randomized to pulmonary vein isolation with either the cryoballoon or the PVAC. Biomarkers were studied for endothelial damage (von Willebrand factor antigen), platelet activation (soluble P-selectin), and coagulation activity [prothrombin fragment 1 + 2 (F1 + 2) and D-dimer] at five different time points during the procedure. Troponin I (Trop I) and C-reactive protein were analysed to reflect myocardial destruction and inflammatory activity. Markers of endothelial damage and platelet activation increased after ablation in both the cryo and the RF group. Similarly, the D-dimer levels increased significantly (P = 0.001) in both groups, whereas the F1 + 2 levels increased after the transseptal puncture only (P = 0.001). The overall activation of the coagulation system was, however, comparable between the groups. The cryoballoon was associated with higher Trop I compared with the PVAC (P < 0.001), but the ratios between biomarkers and Trop I were higher with the PVAC than with the cryoballoon.


CONCLUSIONS
Even though the cryoballoon causes a higher degree of myocardial destruction than the PVAC, markers of coagulation, endothelial damage, and inflammation were comparable between the two techniques.
Department of Cardiology, Department of Medical Sciences, Uppsala University, SE-751 05 Uppsala, Sweden. helena.malmborg@medsci.uu.se
Helena
H
Malmborg
Christina
C
Christersson
Stefan
S
Lönnerholm
Carina
C
Blomström-Lundqvist
D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications* / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000276:immunology; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines
Atrial fibrillation; Catheter ablation; Coagulation; Cryoballoon; PVAC