Myocardial Injury During Radiofrequency Catheter Ablation: Comparison of Focal and Linear Lesions

Abstract

The aim of study was to investigate the extent of myocardial injury incurred by creation of continuous RF current induced linear ablation lesions (LL; ablation of atrial fibrillation, right atrial procedure) in comparison to focal RF lesions (FL; AV node reentry tachycardia, WPW tachycardia). In 23 patients with LL (age 51.3 +/- 11.2 years, 18 men, 5 women) and in 16 patients with FL (age 53.9 +/- 5.1 years, 8 men and 8 women), levels of creatine kinase (CK), myoglobin (MG), CKMB mass (CKMB M), CKMB activity (CKMB A), and cardiac troponin T (cTnT) were determined before and 2, 4, 8, 24, and 48 hours after ablation. CKMB A was normal in 87% in LL and 100% in FL (< 6% of CK) with median maximum CK values of 214 (45-1583) U/L in LL and 36 (29-212) U/L in FL. Peak values of all parameters were significantly higher in LL than in FL. The sensitivity of cTnT was 50% in FL and 100% in LL. In FL MG, total CK, and CKMB M were abnormal in only 12.5% of cases while in LL MG and CKMB M were pathological in 100% and total CK was abnormal in 91.3% of patients. The amount of energy and number of RF applications correlated with cTnT, MG, and CKMB M (P = 0.01). In conclusion, (1) long linear RF current lesions for ablation of atrial fibrillation are associated with significantly greater myocardial injury than focal ablations. (2) In focal lesions only cTnT provided a sensitivity of 50% in the detection of myocardial injury while in linear lesions cTnT, CKMBM, and CKMB M seemed suitable for detection of RF current induced myocardial damage with 100% sensitivity. All biochemical parameters do not differentiate patients with coronary ischemia up to 48 hours after an ablation. (3) Further investigations are necessary to determine if RF current linear lesions lead to impaired atrial contractility in cases of extensive tissue damage.

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

“…In our study, the higher cTnI and CK-MB levels in cryoballoon group may be explained by longer energy delivery duration compared to the other groups. Previous AF ablation studies have found a correlation between levels of cTnT and RF delivery duration and cumulative RF energy [24,27,28], but no data exist regarding other energy sources. Apart from the energy delivery duration, other factors may contribute to higher degree of myocardial injury in cryoablation, as suggested by increased levels of biomarkers post ablation.…”

“…A lower cTn level is expected after RF of focal area with few RF lesions. RF ablation of more myocardial tissue in the atria, such as in PV isolation, is expected to have much higher cTn levels [10][11][12][20][21][22][23][24][25]. Previous clinical studies reported contrasting data, in the setting of AF ablation, on cardiac biomarkers levels after cryoballoon ablation compared to RF ablation [7,[13][14][15][16][17][18][19]26].…”

Sequential Evaluation of Left Ventricular Systolic and Diastolic Function After Radiofrequency Catheter Ablation

“…26) Several biochemical parameters have been validated in the diagnosis of this myocardial damage induced by RF ablation. 2,6) In this regard, we measured CKMB concentrations in all patients before and 8 hours after the procedure. Compared with before the procedure, the CKMB levels significantly increased after the RF ablation (P < 0.001).…”

“…5) Several biochemical parameters have also been validated in the diagnosis of this myocardial damage induced by RF ablation. 2,6) In patients with left ventricular dysfunction, long-term improvement of systolic and diastolic left ventricular function was seen after RF ablation of the atrioventricular junction for rate control of atrial fibrillation. 7,8) Likewise, a reversibility was also observed in left ventricular dysfunction after successful RF catheter ablation of reentrant tachycardia in which AV nodal conduction block was not created.…”

Effect of Radiofrequency Catheter Ablation on Doppler Echocardiographic Parameters in Patients With Wolff-Parkinson-White Syndrome

“…Several biochemical parameters have also been validated in the diagnosis of this myocardial damage induced by RFCA. 38,39) Histologic examination of these lesions reveals coagulation necrosis with destruction of the myofibril architecture and contraction band necrosis. 40) Coagulation necrosis and fibrosis in the atrium may lead to stiff atria with a subsequent increase in A velocity and its VTI.…”