title: Effects of iatrogenic myocardial injury on coronary microvascular function in patients undergoing radiofrequency catheter ablation of atrial fibrillation.
abstract: BACKGROUND
  Iatrogenic myocardial injury by radiofrequency catheter ablation (RFCA) releases proinflammatory substances from damaged myocardium, and these may contribute to endothelial dysfunction in systemic vascular structure. The aim of this study is to evaluate the effect of nonischemic myocardial damage on coronary microvascular function in patients undergoing atrial fibrillation (AF) ablation.
  
  
  RESULTS
  We included 49 patients who underwent AF ablation (paroxysmal AF=25, persistent AF=24) and 34 controls. Immediately before and after RFCA, index of microvascular resistance (IMR) was assessed at left anterior descending coronary artery, and blood samples were obtained for analyses of nitric oxide (NO), activated leukocyte cell adhesion molecule, and lipoprotein-associated phospholipase. Transthoracic echocardiography was performed at baseline, 1 day, 1 month, and 3 months after RFCA. Compared with baseline, IMR, activated leukocyte cell adhesion molecule, and lipoprotein-associated phospholipase increased and NO decreased after RFCA. In 36 subjects with increasing IMR, E/E' ratio increased at 1 day and returned to baseline level at 3 months after RFCA. Changes in activated leukocyte cell adhesion molecule and lipoprotein-associated phospholipase between baseline and after RFCA were independently related to the increase in IMR. In 14 subjects (28.6%), arrhythmia recurred. Using a cutoff value of 9.3 mm Hg/s, sensitivity was 56.7% and specificity was 91.2% for IMR change in predicting AF recurrence (P=0.028).
  
  
  CONCLUSIONS
  Myocardial damage by RFCA provoked coronary microvascular dysfunction through systemic proinflammatory reaction that may contribute to transient diastolic dysfunction. This phenomenon may represent a mechanism for early recurrence of arrhythmia after RFCA.
  
  
  BACKGROUND
  URL: http://cris.cdc.go.kr. Unique identifier: KCT0000030.
authors.affiliation: Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.forename: Cheol Ung
authors.initials: CU
authors.lastname: Choi
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Na
authors.forename: Jong-Il
authors.initials: JI
authors.lastname: Choi
authors.forename: Seong Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Eung Ju
authors.initials: EJ
authors.lastname: Kim
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Han
authors.forename: Sang Weon
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.forename: Chang Gyu
authors.initials: CG
authors.lastname: Park
authors.forename: Hong Seog
authors.initials: HS
authors.lastname: Seo
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
authors.forename: Chun
authors.initials: C
authors.lastname: Hwang
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology*; D003331:Coronary Vessels / Q000503:physiopathology*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D006335:Heart Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance