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Comparison of effects on coagulation and inflammatory markers using a duty-cycled bipolar and unipolar radiofrequency pulmonary vein ablation catheter vs. a cryoballoon catheter for pulmonary vein isolation
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi-arrytmi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi-arrytmi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi-arrytmi.
2013 (Engelska)Ingår i: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 15, nr 6, s. 798-804Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

AIMS:

Thrombo-embolic events are one of the most feared complications related to atrial fibrillation (AF) ablation. Since radiofrequency (RF) energy is thought to be associated with a higher risk of thrombus formation than cryoenergy, the purpose of this study was to assess if the degree of activation of coagulation and inflammatory markers differed between ablation procedures performed with a cryoballoon catheter vs. a RF energy-based pulmonary vein ablation catheter (PVAC), respectively.

METHODS AND RESULTS:

Thirty patients referred for AF ablation were randomized to pulmonary vein isolation with either the cryoballoon or the PVAC. Biomarkers were studied for endothelial damage (von Willebrand factor antigen), platelet activation (soluble P-selectin), and coagulation activity [prothrombin fragment 1 + 2 (F1 + 2) and D-dimer] at five different time points during the procedure. Troponin I (Trop I) and C-reactive protein were analysed to reflect myocardial destruction and inflammatory activity. Markers of endothelial damage and platelet activation increased after ablation in both the cryo and the RF group. Similarly, the D-dimer levels increased significantly (P = 0.001) in both groups, whereas the F1 + 2 levels increased after the transseptal puncture only (P = 0.001). The overall activation of the coagulation system was, however, comparable between the groups. The cryoballoon was associated with higher Trop I compared with the PVAC (P < 0.001), but the ratios between biomarkers and Trop I were higher with the PVAC than with the cryoballoon.

CONCLUSION:

Even though the cryoballoon causes a higher degree of myocardial destruction than the PVAC, markers of coagulation, endothelial damage, and inflammation were comparable between the two techniques.

Ort, förlag, år, upplaga, sidor
2013. Vol. 15, nr 6, s. 798-804
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
Kardiologi
Identifikatorer
URN: urn:nbn:se:uu:diva-196307DOI: 10.1093/europace/eus411ISI: 000319468300010PubMedID: 23362019OAI: oai:DiVA.org:uu-196307DiVA, id: diva2:609810
Tillgänglig från: 2013-03-07 Skapad: 2013-03-07 Senast uppdaterad: 2017-12-06Bibliografiskt granskad
Ingår i avhandling
1. Catheter Ablation of Atrial Fibrillation and Atrial Flutter: A Comparison of Cryo and Radiofrequency Techniques
Öppna denna publikation i ny flik eller fönster >>Catheter Ablation of Atrial Fibrillation and Atrial Flutter: A Comparison of Cryo and Radiofrequency Techniques
2014 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Atrial fibrillation (AF) and atrial flutter (AFl) are two of the most common arrhythmias encountered in the population. Catheter ablation has emerged as a useful tool in the treatment of these arrhythmias. Although radiofrequency (RF) is the most commonly used energy source for ablation, cryoenergy may have some advantageous properties. The purpose of these studies was to evaluate and compare ablation with novel ablation catheters using either of these energy sources.

When used for AFl ablation, cryoenergy was associated with less perceived pain than radiofrequency. However, the acute success rate was significantly lower for cryoablation (56%) compared with RF ablation (100%) in our study.

Being one of the first centres to use a new so-called “one-shot” device for pulmonary vein isolation (PVI), the cryoballoon, we described our initial experience with this catheter in 40 patients undergoing AF ablation.  A high rate of PVI could be achieved although an additional cryocatheter was needed in 44% of the procedures. Freedom from arrhythmia-related symptoms was seen in 53% after a mean follow-up of 8.9 months.

Comparing the cryoballoon and a RF-based device intended for PVI, the pulmonary vein ablation catheter (PVAC), both catheters proved comparably effective (≥93%) and safe in achieving PVI with comparable procedure times. After 12 months only 46% versus 34% (ns) in the cryoballoon- and the PVAC group, respectively, were regarded as free from AF without antiarrhythmic drugs, after one ablation procedure, whereas 60% versus 54% reported clinical success. Quality of life was significantly increased in both groups, to a level comparable with the general Swedish population.

We tested the hypothesis that RF ablation would be accompanied by a higher activation of the coagulation and inflammatory systems, measured by biomarkers. Such a difference could not be supported in our study, which showed a comparable response with either technique, even though the cryoballoon caused more pronounced myocardial damage.

Two different energy settings with different ratios of bipolar-to-unipolar energy were tested with the PVAC under the hypothesis that ablation with a higher proportion of unipolar energy would require fewer applications in order to achieve PVI. However, this study failed to show any difference between the groups.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2014. s. 90
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 959
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-212806 (URN)978-91-554-8830-7 (ISBN)
Disputation
2014-02-14, Enghoff salen, Ing 50, Akademiska sjukhuset, Uppsala, 09:15 (Engelska)
Opponent
Handledare
Tillgänglig från: 2014-01-23 Skapad: 2013-12-14 Senast uppdaterad: 2014-02-10

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Malmborg, HelenaChristersson, ChristinaLönnerholm, StefanBlomström-Lundqvist, Carina
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