Evaluation Of Myocardial Damage Induced By Radiofrequency Catheter Ablation And The Comparison Of Myocardial Damage Between Using Saline-irrigated Ablation Catheter And Conventional Ablation Catheter

Objective:The study assessed the changes in levels of serum biochemical markers:creatine kinase (CK), creatine kinase isoenzyme (CK-MB), cardiac troponin T(cTnT), lactate dehydrogenase(LDH),NT-proBNP,hs-CRP in patients who underwent radiofrequency catheter ablation(RFCA). we sought to evaluate the extent of cardiac injury induced by RFCA. This study also compared the markers of myocardial damage incurred between the conventional ablation catheter and the saline-irrigated ablation catheter.Methods:We analyzed the data of 231consecutiv patients who underwent RFCA, including 115 males and 116 females,average age:(47.1±14.9y).The patients were divided into focal RF lesions group(FL, n=194) and linear RF lesions group(LL, n=37). CK,CK-MB,cTnT,LDH NT-proBNP,hs-CRP levels were measured before, 4h,12h,24h after RFCA. The time of ablation, number of RFCA discharges, cumulative energy were recorded during the procedure. We investigate the parameters of FL group in comparison to LL group and analysis the correlation of myocardial damage markers with the time, number of RFCA discharges, energry and the extent of cardiac injury among the different ablation sites; According to the kind of ablation catheter, we divide the FL group into conventional ablation catheter(n=160) and saline-irrigated ablation catheter goup(n=37). The CK,CK-MB,cTnT levels were compared between two groups.Results:There were uncomplicated in all the patients enrolled. The baseline cTnT levels of two groups were within the normal range (<0.01ng/ml),both rose significantly after RFCA(FL:0.26±0.36ng/ml Median:0.15, LL:0.35±0.22ng/ml Median:0.28 P<0.001),sensitivity (FL:91.8% VS LL:100%).Post-ablation the concentration of CK,CK-MB were significantly than the baseline levels in the FL group. However, there were no significantly different in the LL group (P=0.695,0.803).CK were statistical significance between two groups post-ablation(P=0.118),CK-MB level of FL group was significantly higher than LL group(17.3±8.7U/L VS 14.9±4.8U/L, P=0.023), The mean and peak CK-MB sensitivity in two gourps(FL:14.4% VS LL:0%,P=0.029).As for Inflammation Marker hs-CRP and LDH,there were also significantly different between pre-ablation and post-ablation (P<0.001).LL group rose higer than the FL group(P<0.001).The sensitivity is (LDH:FL:5.7% VS LL:24.3%, P= 0.001),(hs-CRP:FL:11.8% VS LL:64.5%,P<0.001). NT-proBNP of both group were no significantly different between pre-ablation and post-ablation (P=0.695,P=0.326),but the LL group's NT-proBNP level of baseline and post-ablation were significantly higher than the FL group.(P<0.001).The peak parameter levels correlated with the ablation time and cumulative energy. cTnT has the strongest correlation(r=0.536, r=0.482, P<0.001),The number of RFCA discharges correlated with the CK-MB,cTnT,LDH peak levels, but correlation were relatively weak. The different ablation site also correlated with the extent of myocardial injury, ablation in the ventricular wall detected the highest cTnT and CK-MB levels, which correlated with the cumulative energy, followed by the AF/AFL/AT ablation, the slowpath lesion produce lowest increase in cTnT, CK-MB levels; Compared the degree of myocardial injury incurred by conventional ablation catheter and the saline-irrigated ablation catheter, The CK,CK-MB,cTnT were no significantly different between two group before ablation. markers' peak levels in saline-irrigated ablation catheter group rose significantly higher than the conventional ablation catheter group after RFCA.Conclusion:RFCA can produce focal minor myocardial damage, cTnT is a sensitive marker to detect such damage. Compared with acute myocardial infarction (AMI),the elevation of cTnT incurred by RFCA has a earlier peak time and lower peak levels. However, it is limited to different diagnose the myocardial injury incurred by AF/AFL/PVC/VT ablation and the cardiac ischaemia or infarction depended with cTnT; the post-ablation cTnT levels positively correlated with the ablation time, cumulative energy and the number of RFCA discharges; Lesions applied to ventricular endocardium are associated with significantly greater myocardial damage, followed by the lesions of atrial endocardium. Lesions in the annuls were associated with lowest myocardial damage; The saline-irrigated ablation catheter can produce more significant myocardial damage in comparison to the conventional ablation catheter.