Key result
Epicardial monopolar RF ablation linked to higher myocardial injury and inflammatory markers versus endocardial ablation.
Why the study?
There was a need to assess myocardial damage after radiofrequency ablation of the pulmonary veins for persistent atrial fibrillation in elderly patients.
Does radiofrequency ablation of the pulmonary veins cause progressive myocardial injury, oxidative stress, and inflammatory response in elderly patients with persistent atrial fibrillation?
Observational
Does radiofrequency ablation of the pulmonary veins cause progressive myocardial injury, oxidative stress, and inflammatory response in elderly patients with persistent atrial fibrillation?
Radiofrequency ablation for persistent AF in elderly patients is associated with progressive myocardial injury, oxidative stress, and reduced myocardial blood flow up to 5 months, particularly with epicardial monopolar ablation.
May warrant caution with epicardial monopolar ablation in elderly persistent AF; leaves open optimal technique pending RCTs.
BACKGROUND: There is a need to assess myocardial damage after radiofrequency ablation of the pulmonary veins (PV) for persistent atrial fibrillation (PAF) in elderly patients. OBJECTIVE: To evaluate oxidative stress, inflammatory response and myocardial damage in elderly patients with PAF after radiofrequency ablation of the PV. METHODS: High-sensitivity troponin T (hsTnT), malondialdehyde-modified low-density lipoprotein (MDA-LDL), acrolein (ACR), lipid hydroperoxide (LHP), toll-like receptor 4 (TLR4), soluble growth stimulation expressed gene 2 (sST2), angiotensin II (Ang II) and myocardial blood flow (MBF) were determined before ablation and at 1, 3 and 5 months after radiofrequency ablation. RESULTS: The levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2 and Ang II were increased 3 months after ablations compared with before ablation and 1 month after ablation, respectively (P<0.001); they were further increased at 5 months after ablation compared with the 1- and 3-month groups, respectively (P<0.001). MBF was decreased in the 3 months group after ablations compared with before ablation and 1-month after ablation, respectively (P<0.001), and was further decreased in 5-months after ablations compared with 1-month and 3-month groups, respectively (P<0.001). Patients with epicardial monopolar radiofrequency ablation had higher levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2, Ang II and lower MBF than patients with endocardial monopolar and bipolar radiofrequency ablations, respectively (P<0.001). CONCLUSION: Monopolar radiofrequency ablation method could result in more myocardial injury than bipolar radiofrequency ablation. Oxidative stress and inflammatory response may be involved in cardiac radiofrequency ablation-induced myocardial injury, resulting in myocardial ischemia in elderly patients with PAF.
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Li et al. (2024) conducted an observational in Persistent atrial fibrillation (PAF). Radiofrequency ablation vs. Baseline and between ablation methods (epicardial monopolar, endocardial monopolar, bipolar) was evaluated on Levels of hsTnT, MDA-LDL, ACR, LHP, TLR4, sST2, Ang II and MBF (p=<0.001). Epicardial monopolar radiofrequency ablation resulted in higher levels of myocardial injury and inflammatory markers than endocardial monopolar and bipolar ablation (P<0.001).
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