Effects of cryoablation and radiofrequency ablation on endothelial and blood clotting activation

Abstract

Cryoablation (CA) emerged as an alternative procedure to radiofrequency (RF). The aim of this study was to compare haemostatic system alterations in patients undergoing RF or CA for atrioventricular nodal reentrant tachycardia ablation. von Willebrand factor (vWF), spontaneous whole blood platelet aggregation, prothrombin fragment F1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), plasminogen activator inhibitor type-1 (PAI-1), and clot lysis time (CLT) were determined in 48 patients (27 CA; 21 RF; 19M/29F, mean age 49.6 ± 17.6 years). Blood samples were obtained before the procedure (T0), immediately after (T1), and 24 h later (T2). At T1 both procedures were associated with a significant increase in levels of the endothelial activation marker vWF. At T2 vWF levels were lower in CA than in RF group. No changes in whole blood platelet aggregation before and after ablation procedures were observed. At T1 both groups determined an increase in blood clotting activation markers, F1 + 2, TAT, and DD. At T2 F1 + 2, TAT and DD levels were similar to baseline values. The comparison between RF and CA showed no significant differences in F1 + 2 and TAT levels, whereas at T1 DD levels were higher in CA group than in RF group. Both procedures induced a significant decrease in CLT, whereas no changes in PAI-1 levels were found. There were no significant differences in CLT and PAI-1 levels. The fibrinolytic efficiency analysis showed that at T1 DD/TAT and DD/F1 + 2 ratios were lower in RF group and remained lower in RF than in CA group at T2. CA procedure may be associated with a lower degree of endothelial damage and with a higher fibrinolytic capacity respect to RF.

Efficacy and safety of uninterrupted low-intensity warfarin for cryoballoon ablation of atrial fibrillation in the elderly: A pilot study

“…In humans, it was also found that cryoablation was associated with less endothelial damage and inflammation, and a higher fibrinolytic capacity. However, recently, a meta‐analysis reported that no differences in the incidence of stroke/TIA were found between RFCA and CB‐A. The reason for the discrepancy between animal experiments and clinical practice is unclear.…”

“…Compared to RFCA, CB‐A leads to less endothelial damage and inflammation, so CB‐A seems to be less thrombogenic. Thus, we speculated that uninterrupted low‐intensity warfarin might be appropriate during the periprocedural period of CB‐A for AF in the elderly. This study aimed to evaluate the efficacy and safety of uninterrupted low‐intensity warfarin during the periprocedural period of CB‐A for AF in the elderly.…”

Efficacy and Safety of Uninterrupted Low-Intensity Warfarin for Radiofrequency Catheter Ablation of Atrial Fibrillation in the Elderly

“…In humans, when a similar degree of myocardial destruction was caused by ablation, cryoablation was associated with less endothelial damage and inflammation and a higher fibrinolytic capacity compared with RFCA. 22,23 Recently, a meta-analysis reported that bleeding complications of cryoablation were significantly more frequent than that of RFCA. 24 These results suggested that patients receiving cryoablation might benefit more from uninterrupted low-intensity warfarin.…”

Innovative Approaches to Assess the Impact and Steps to Decrease the Neurological Consequences of Ablation

“…100 Furthermore, activation of platelets and the coagulation cascade by the delivery of RF or cryoenergy can induce a prothrombotic state. 101 Radiofrequency versus cryoablation. The incidence of SCLs/ SCEs has been studied when different types of energy sources were used for AF thermal ablation.…”