title: Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence.
abstract: BACKGROUND
  Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels.
  
  
  OBJECTIVE
  This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters.
  
  
  METHODS
  We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence.
  
  
  RESULTS
  Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p < 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p < 0.005) in the CBA group, while it was correlated with application time in the RFA group (p < 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p > 0.05).
  
  
  CONCLUSIONS
  The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.
authors.affiliation: Istanbul Medipol University, Istanbul, Turkey. filizkizilirmak@hotmail.com.
authors.forename: Filiz
authors.initials: F
authors.lastname: Kızılırmak
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gokdeniz
authors.forename: Haci Murat
authors.initials: HM
authors.lastname: Gunes
authors.forename: Gultekin Gunhan
authors.initials: GG
authors.lastname: Demir
authors.forename: Beytullah
authors.initials: B
authors.lastname: Cakal
authors.forename: Gamze Babur
authors.initials: GB
authors.lastname: Guler
authors.forename: Ekrem
authors.initials: E
authors.lastname: Guler
authors.forename: Fatih Erkam
authors.initials: FE
authors.lastname: Olgun
authors.forename: Fethi
authors.initials: F
authors.lastname: Kilicaslan
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000473:pathology / Q000601:surgery*; D015415:Biomarkers; D017115:Catheter Ablation / Q000009:adverse effects*; D003402:Creatine Kinase / Q000097:blood; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D003402:Creatine Kinase
keywords: atrial fibrillation; catheter ablation; myocardial injury biomarkers