Early recurrence after cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: mechanism and implication in long-term outcome

Abstract

Background Early recurrence (ER) after catheter ablation for atrial fibrillation (AF) has been considered as a common phenomenon but its mechanism and implication in long-term outcome has not been fully elucidated. We aimed to clarify the relation between post-ablation inflammation and ER after cryoballoon ablation (CBA) or radio-frequency ablation (RFA) and evaluate the clinical significance of ER. Methods A total of 154 patients with paroxysmal AF undergoing ablation were consecutively recruited, including 90 patients undergoing RFA (RF group) and 64 patients undergoing CBA (CB group). Myocardial injury and inflammation biomarkers were analyzed before and 6 h, 24 h and 48 h after ablation. Acute early recurrence (AER), non-acute early recurrence (NAER) and late recurrence (LR) was defined as recurrence of atrial tachyarrhythmia during 0–3, 4–90 days and beyond a 90-day blanking period after ablation. Results Cardiac troponin I was significantly higher in CB group while C reactive protein (CRP) and Ratio Neutrophil/Lymphocyte were more elevated in RF group. Higher CRP level after RFA was significantly associated with AER in RF group and lower CRP level after CBA was predictive of AER in CB group. In addition, average cryoablation duration was positively correlated with CRP level after CB group. Cox regression revealed that NAER and left atrial diameter were associated with LR in RF group, while AER and NAER were predictive of LR after CBA. Conclusions Post-ablation inflammation was greater in RFA than in CBA. Excessive inflammatory response may be an important factor of AER after RFA. AER after CBA was related with lower inflammation and predictive of LR. Further investigations are still warranted to address on these findings.

Long‐term clinical impact of early recurrence of atrial tachyarrhythmia after cryoballoon ablation in patients with atrial fibrillation

“…This pattern suggests that ERAT may occur more promptly following CBA as compared to RFA. Wei et al have shown that postablation inflammation is more pronounced in RFA than in CBA, evidenced by elevated levels of inflammatory markers such as cardiac troponin I, C‐reactive protein, and the neutrophil to lymphocyte count ratio 28 . This heightened inflammatory response could play a significant role in ERAT following RFA.…”

Machine learning-based analysis of risk factors for atrial fibrillation recurrence after Cox-Maze IV procedure in patients with atrial fibrillation and chronic valvular disease: A retrospective cohort study with a control group

“…In addition, our study found that early postoperative AF recurrence is correlated with final AF recurrence. Specifically, the presence of postoperative early recurrence, which may be related to the postoperative excessive inflammatory response (57,58), significantly increases the risk of late AF recurrence. This finding is consistent with previous research on radiofrequency catheter ablation by Kim et al (59).…”

Utility of short‐time electrocardiogram to assess risk for atrial arrhythmia recurrence: Impact of atrial premature beat occurrence 1 day after pulmonary vein isolation for atrial fibrillation

“…Additionally, changes in inflammation markers, assessed by hs‐CRP and NLR, did not differ between the two groups, indicating that inflammatory response was not the only factor associated with APB occurrence 1 day after PVI. The levels of hs‐CRP and NLR might depend on different energy sources for PVI, and inflammatory response is reported to be higher in PVI with low‐power (30–35 W) RFCA compared to PVI with CBA 10,11 . However, the differences in inflammatory response have not been fully studied between PVI with high‐power (45–50 W) RFCA and CBA.…”

“…The laboratory data included creatinine, estimated glomerular filtration rate, and brain natriuretic peptide. High‐sensitivity C‐reactive protein (hs‐CRP) and neutrophil/lymphocyte ratio (NLR), calculated as a simple ratio between the neutrophil and lymphocyte counts, were assessed as inflammation markers 1 day before and 1 day after PVI 9–11 …”

“…RFCA compared to PVI with CBA. 10,11 However, the differences in inflammatory response have not been fully studied between PVI with high-power (45-50 W) RFCA and CBA. In the present study, changes in hs-CRP and NLR did not differ between the PVI with high-power (45-50 W) RFCA and CBA.…”