Evolution Of Myocardial Injury And Inflammation After Cryoballoon Ablation For Atrial Fibrillation

PURPOSE:Evolution of myocardial injury and inflammation after cryoballoon ablation(CBA)for atrial fibrillation(AF)has not been completely investigated.We aimed to evaluate myocardial injury and inflammation caused by CBA,to compare with different factors such as myocardial ischemia and RFA and to study the relationship between myocardial injury,inflammation and outcome of AF.PATIENTS AND METHODS:1.A total of 150 patients hospitalized in Ruijin Hospital from August 2014 to July 2015were recruited,including 50 AF patients treated with cryoballoon(AF group),50Patients with stable angina undergoing elective percutaneous coronary intervention(PCI)(SA group)and 50 patients with acute coronary syndrome(ACS)undergoing emergency PCI(ACS group).Myocardial injury and inflammation biomarkers were analyzed before and 24h,48 hours and 72h after intervention.2.A total of 253 patients with paroxysmal AF ablated in the NHC Hospital in France from March 2010 to December 2015 were recruited,including 164 patients undergoing RFA(RF group)and 83 patients undergoing CBA(CB group).Myocardial injury and inflammation biomarkers were analyzed before and 6h,24h and 48h after intervention.Acute phase postoperative was defined 72h after intervention,during which patients'heart rhythm were monitored.RESULTS:1.CKMB and c Tn I levels were stable before and after intervention in SA group.CKMB and c Tn I levels in AF group and ACS group peaked at 24h after intervention,and hs CRP peaked at 48h after intervention with greater elevation in ACS group.Ratio of hs CRP and c Tn I(hs CRP/c Tn I)was much higher in AF group than ACS group and correlation between c Tn I and hs CRP was found in both groups(r=0.28,p<0.05,AF group 48h;r=0.35,p<0.05,ACS group 48h).Hs CRP/c Tn I at 24h and 48h after intervention could be used as a factor to identify myocardial injury caused by ablation and acute myocardial ischemia(hs CRP/c Tn I_24h:0.66,sensitivity 0.74,specificity 0.83;hs CRP/c Tn I_48h:2.70,sensitivity 0.70,specificity 0.88).2.CTn I level in CB group was significantly higher than that in RF group,while CRP and N/L in RF group were significantly higher than those in CB group.CRP/c Tn I in RF group was significantly higher than that in CB group.Recurrence during acute phase was occurred in 13 patients(7.9%)in the RF group and 3 patients(3.6%)in CB group.Multivariate regression analysis showed that CRP 24h post-intervention was an independent factor in the RF group(OR=1.081,p<0.05).In RF group,CRP level in non-recurrence patients was significantly lower than that in recurrence patients(P<0.01),and the opposite situation was found in CB group.CONCLUSION:1.AF patients undergoing CBA exhibited similar timing of myocardial injury and inflammation biomarkers release compared with ACS patients undergoing emergent PCI.The ratio of these two biomarkers existed a significant difference between these two groups,indicating unique kinetics of cardiac biomarker release after CBA for AF.Furthermore,ratio of hs CRP/c Tn I could serve for the differential of myocardial injury caused by cryoablation or acute ischemia.2.Myocardial injury after CBA for AF was more important than after RFA,while systematic inflammation was more intense after RFA than after CBA.Incidence of AF recurrence during acute phase is similar after CBA and after RFA.Excessive inflammatory response may be an important factor in acute AF recurrence after RFA but not after CBA.Future exploration for the understanding of the mechanisms of acute recurrence after CBA is needed for the post-ablation management of AF.