Intracardiac Fibrinolysis and Endothelium Activation Related to Atrial Fibrillation Ablation with Different Techniques

Objective. The effect of pulmonary vein isolation (PVI) on fibrinolytic and endothelial activation with currently applied periprocedural anticoagulation has not been explored. We measured markers of fibrinolysis and endothelium activation before and after PVI with the second-generation cryoballoon (...

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Published in:Cardiology research and practice 2020, Vol.2020 (2020), p.1-8
Main Authors: Nagy, László, Clemens, Marcell, Csiba, László, Csanádi, Zoltán, Nagy, Attila, Sarkady, Ferenc, Kovács, Kitti Bernadett, Kiss, Alexandra, Urbancsek, Réka, Tóth, Noémi Klára, Bagoly, Zsuzsa, Hajas, Orsolya, Oláh, Anna V.
Format: Article
Language:English
Subjects:
Ablation
Ablation (Surgery)
Anticoagulants
Anticoagulants (Medicine)
Atrial fibrillation
Blood clots
Blood coagulation factor VIII
Cardiac arrhythmia
Catheters
Electrodes
Endothelium
Heart
Methods
Veins & arteries
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Summary:Objective. The effect of pulmonary vein isolation (PVI) on fibrinolytic and endothelial activation with currently applied periprocedural anticoagulation has not been explored. We measured markers of fibrinolysis and endothelium activation before and after PVI with the second-generation cryoballoon (Cryo), pulmonary vein ablation catheter (PVAC-Gold), and irrigated radiofrequency (IRF). Methods. Markers of fibrinolysis and endothelium activation in left atrial (LA) blood samples were measured in 31 patients before and after PVI (Cryo:10, PVAC-Gold: 7, IRF: 14). Periprocedural anticoagulation included uninterrupted vitamin K antagonist and iv heparin (ACT≥300 sec) during LA dwelling. Results. Levels of D-dimer (median; interquartile range, mgFEU/L) increased with all techniques (PVAC: 0.34; 0.24–0.50 versus 0.70; 0.61–1.31; p=0.0313, Cryo: 0.33; 0.28–0.49 versus 0.79; 0.65–0.93; p=0.0078; IRF 0.33; 0.21–0.44 versus 0.83; 0.56–1.21; p=0.0001). PAP complex level (ng/ml) increased after Cryo (247.3, 199.9–331.6 versus 270.9, 227.9–346.7; p=0.0020) and IRF (265.3; 202.0–800.1 versus 325.6, 250.2–701.9; p=0.0166), but not after PVAC (p=0.2969). PAI-1 activity (%) decreased with the PVAC (1.931; 0.508–3.859 versus 0.735, 0.240–2.707; p=0.0313) and Cryo (0.361; 0.080–1.575 versus 0.378; 0.111–0.915; p=0.0313). A similar trend was observed with IRF (p=0.0676). Both VWF antigen levels and FVIII activity increased after PVI with all the 3 techniques. The levels of soluble VCAM-1 (ng/ml) did not change after PVAC procedures, but increased after Cryo (542, 6; 428.5–753.1 versus 619.2; 499.8–799.0; p=0.0005) and IRF (679.3; 505.0–744.7 versus 770.9; 631.9–894.0; p
ISSN:2090-8016
2090-0597
2090-0597
DOI:10.1155/2020/1570483