December 2, 2013Cardiology JournalOpen Access

Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation

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Why the study?

Does the choice of ablation technology (cryoballoon, laser balloon, contact-force RF) compared to conventional RF affect acute myocardial injury biomarker rise in patients with paroxysmal atrial fibrillation?

Structured PICO

Population

110 adults with drug-refractory paroxysmal atrial fibrillation, mean age 57.2, 76% male, with normal baseline values for myocardial injury.

Intervention

Pulmonary vein isolation using cryoballoon (n=35), visually guided laser balloon (n=20), or open-irrigated tip radiofrequency catheter with contact-force-sensing technology (n=20)

Comparator

Pulmonary vein isolation using conventional open-irrigated tip radiofrequency catheter (n=35)

Outcome

Acute myocardial injury biomarker rise (cardiac troponin I and creatinine kinase-MB) at 19 ± 3 h and 43 ± 3 h post-ablationsurrogate

Cryoballoon ablation for atrial fibrillation causes greater acute myocardial injury compared to radiofrequency or laser balloon ablation, though this does not translate to differences in clinical recurrence.

Limitations

Only 2 measurements of biomarkers were performed
No serial measurements to assess peak or kinetics of biomarkers

Implication

Supports cryoballoon use despite higher biomarkers; challenges direct link between acute injury and AF recurrence.

Abstract

BACKGROUND: Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies. METHODS AND RESULTS: One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 ± 3 h and 43 ± 3 h after ablation. At the first postprocedural sample, cTnI and CK-MB levels were found elevated in all 110 patients with a median value of 2.11 ng/mL and 8.95 ng/mL, respectively. Group B showed cTnI levels increased (median 5.96 ng/mL) compared to other groups (median Group A: 1.72 ng/mL, Group C: 1.54 ng/mL, Group D: 2.0 ng/mL; p < 0.001). Also CK-MB levels resulted higher in cryoablation (median 26.4 ng/mL) compared to other groups (median Group A: 6.40 ng/mL, Group C: 7.15 ng/mL, Group D: 6.50 ng/mL; p < 0.001). No significant association was observed between biomarker levels and recurrences of atrial fibrillation after a mean follow-up of 369 ± 196 days. CONCLUSIONS: Highest markers for myocardial injury were observed in the cryoballoon group. It is possible that a longer delivery energy duration and other factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown.