Key result
Radiofrequency catheter ablation for ventricular arrhythmias resulted in elevated S-100B protein levels in 43% of patients, which correlated with worse renal function, higher NT-proBNP, and sevoflurane anesthesia.
Why the study?
Does radiofrequency catheter ablation for ventricular arrhythmias cause asymptomatic central nervous system damage as measured by S-100B protein levels?
Observational (n=23)
No
Does radiofrequency catheter ablation for ventricular arrhythmias cause asymptomatic central nervous system damage as measured by S-100B protein levels?
Elevation of S-100B protein after catheter ablation for ventricular arrhythmias is relatively common and correlates with renal insufficiency, heart failure severity, and sevoflurane anesthesia, though without macroscopic CNS changes.
S-100B elevations after ventricular arrhythmia ablation should not change practice; leaves open subclinical CNS injury and requires prospective validation.
CĂl: ZhodnocenĂ vlivu radiofrekvenÄnĂ katĂŠtrovĂŠ ablace (RFA) komorovĂ˝ch arytmiĂ na asymptomatickĂŠ postiĹženĂ centrĂĄlnĂho nervovĂŠho systĂŠmu (CNS) pomocĂ proteinu S-100B. DĂĄle identifikace faktorĹŻ predikujĂcĂch zvýťenĂ hodnoty proteinu S-100B po RFA.Metodika: Po sobÄ jdoucĂ pacienti podstoupivĹĄĂ RFA pro komorovĂŠ arytmie v obdobĂ od listopadu 2015 do srpna 2016. Hodnota proteinu S-100B mÄĹena pĹed vĂ˝konem, ihned po vĂ˝konu, za 8 a 24 hodin po vĂ˝konu. V pĹĂpadÄ nadlimitnĂ hodnoty proteinu S-100B za 24 hodin po vĂ˝konu doplnÄnĂ vĂ˝poÄetnĂ tomografie (CT) CNS a neurologickĂŠho vyĹĄetĹenĂ.Soubor pacientĹŻ: TĹiadvacet pacientĹŻ, z toho bylo 19 muŞů a 4 Ĺženy ve vÄku 62 ± 8 let. Ischemickou chorobu srdeÄnĂ (ICHS) s jizvou po IM mÄlo 18 pacientĹŻ (78 %), dva pacienti trpÄli dilataÄnĂ kardiomyopatiĂ (DKMP), dva pacienti idiopatickou komorovou tachykardiĂ, jeden pacient non-kompaktnĂ kardiomyopatiĂ (LVNC).EjekÄnĂ frakce levĂŠ komory (EFLK) byla 29 ± 8 %. VĹĄichni pacienti mÄli implantabilnĂ kardioverter-defibrilĂĄtor (ICD). TĹi pacienti (13 %) podstoupili RFA kombinovanĂ˝m endoepikardiĂĄlnĂm pĹĂstupem. U pÄti pacientĹŻ (22 %) byl vĂ˝kon realizovĂĄn v celkovĂŠ anestezii.VĂ˝sledky: AlespoĹ jednu nadlimitnĂ hodnotu proteinu S-100B jsme identifikovali u deseti pacientĹŻ (43 %). Po 24 hodinĂĄch byla pĹekroÄena hraniÄnĂ hodnota proteinu S-100B u tĹĂ pacientĹŻ (13 %). Ani u jednoho z tÄchto pacientĹŻ jsme nevidÄli akutnĂ zmÄny na CT CNS Äi pĹi neurologickĂŠm vyĹĄetĹenĂ. DĂŠlka vĂ˝konu, ablaÄnĂ Äas, nutnost defibrilace v prĹŻbÄhu vĂ˝konu, intenzita antikoagulace v prĹŻbÄhu vĂ˝konu byly bez statisticky vĂ˝znamnĂŠho vlivu na zvýťenĂ koncentracĂ proteinu S-100B.Skupina pacientĹŻ se zvýťenĂm koncentrace proteinu S-100B mÄla statisticky vĂ˝znamnÄ horĹĄĂ renĂĄlnĂ funkce reprezentovanĂŠ sĂŠrovou koncentracĂ kreatininu (127 ± 41 vs. 100 ± 25 µmol/l, p = 0,02). DalĹĄĂm faktorem, kterĂ˝ statisticky vĂ˝znamnÄ predikoval poablaÄnĂ zvýťenĂ koncentrace proteinu S-100B, se ukĂĄzala bĂ˝t pokroÄilost srdeÄnĂho selhĂĄnĂ mÄĹenĂĄ pomocĂ hodnot N-terminĂĄlnĂho fragmentu natriuretickĂŠho propeptidu typu B (NT-proBNP) (4 417 vs. 1 634 ng/l, p = 0,05). Statisticky vĂ˝znamnĂ˝ vliv na elevaci proteinu S-100B mÄlo v naĹĄem souboru uĹžitĂ celkovĂŠ anestezie sevofluranem (p = 0,03).ZĂĄvÄr: Ke zvýťenĂ koncentrace proteinu S-100B po katĂŠtrovĂŠ ablaci pro komorovĂŠ arytmie v naĹĄem souboru dochĂĄzelo relativnÄ Äasto. MakroskopickĂŠ zmÄny na CNS jsme neidentifikovali na CT ani pĹi neurologickĂŠm vyĹĄetĹenĂ.PokroÄilost renĂĄlnĂ insuficience, pokroÄilost srdeÄnĂho selhĂĄnĂ a pouĹžitĂ inhalaÄnĂ anestezie sevofluranem korelujĂ s mnoĹžstvĂm proteinu S-100B jako biomarkeru asymptomatickĂŠho postiĹženĂ CNS u pacientĹŻ lĂŠÄenĂ˝ch radiofrekvenÄnĂ katĂŠtrovou ablacĂ pro komorovĂŠ arytmie.
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Šušková et al. (2017) conducted an observational in Ventricular arrhythmias (n=23). Radiofrequency catheter ablation was evaluated on Elevation of S-100B protein above cut-off value (0.105 μg/l) at any time up to 24 hours post-ablation. Radiofrequency catheter ablation for ventricular arrhythmias resulted in elevated S-100B protein levels in 43% of patients, which correlated with worse renal function, higher NT-proBNP, and sevoflurane anesthesia.
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