| Objective: Myocardial injury exist after catheter ablation in patients with paroxysmal atrial fibrillation in short time.However,the degree of myocardial injury in patients with paroxysmal atrial fibrillation after ablation was different when useing different energy sources.Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation radiofrequency catheter ablation(RFCA)and cryoballoon catheter ablation(CBCA),and the relationship between the trends of myocardial injury biomarker and recurrence of atrial fibrillation,so as to guide the clinical treatment of paroxysmal atrial fibrillation(AF).Method: One hundred and forty-eight patients with paroxysmal AF hospitalized at the Second Hospital of He be Medical University between March 2015-February 2017 were treated with pulmonary vein isolation with 2 different technologies:radiofrequency catheter in 79 patients and cryoballoon in 69 patients.History taking and preoperative examination complecated in all patiens.RFCA and CBCA were performed by the same surgeon useing CARTO 3.0 system for electroanatomical mapping and ablation.Elbow vein bloodcollected before and after CA at 1 day,2 days,3 days,1week,2weeks to measure the changes of creatinine kinase(CK),creatinine kinase-MB(CK-MB)and cardiac troponin I(c Tn I).AF recurrence were followed up according to the patient's symptoms,12 lead electrocardiogram(ECG)or 24 hour Holter ECG.Data were processed with SPSS 16.0 software.When data are subject to normal distribution,continuous variables were expressed as the mean ± standard deviation,groups comparison were using independent sample t test.Comparing different points within the same group usingsingle factor repetitive measure analysis of variance.Count data applied frequency and percentage,using the ?2 test or Fisher's exact test.The logistic regression analysis was used analyzing the related factors of recurrence of atrial fibrillation.P <0.05 was considered statistically significant.Results:1 The comparison of General clinical features:The RFCA group and the CBCA group have no diffrences in the general clinical characteristics of sex,age,diameter of left atrial,etc.(P>0.05).Pulmonary vein isolation were completed in all patients.No thromboembolic events,cardiac tamponade and other complications occurred in the subjects.2 The myocardial injury indicatorsMyocardial enzyme,troponin was at the normal level in 138 patients.Of the 10 patients with slightly increased myocardial enzyme and troponin,cardiovascular disease was excluded according to the coronary angiography or clinical symptom.2.1 CK:In RFCA group,1 day after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),it is a downward trend at 2 days,3 days,1 week after surgery.It returned to the preoperative level at the 3 days after surgery.2 weeks after operation increased slightly,but there was no significant difference compared with the preoperative and 1 week postoperative(P>0.05).In CBCA group,1day after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),it was a downward trend at 2 days,3 days,1 week after surgery.It returned to the preoperative level at the 3 days after surgery,and reached the lowest point at 1 weeks after operation.2 weeks after operation increased slightly,but there was no significant difference compared with the preoperative and 1 week postoperative(P>0.05).Comparing between groups,there were significant differences at 1 day and 2 days after ablation(P<0.05)and there was no difference at 3 days,1 week and 2 weeks after ablation and preoperative(P>0.05).2.2 CK-MB:In RFCA group,1 day after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),it slightly decreased at 2 days and 3 days after surgery.It returned to the preoperative level at the 2 days after surgery.It continued to declined at 1week and 2 weeks after operation,the difference with preoperative was statistically significant(P<0.05).In CBCA group,1 day after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),It significantly decreased at 2 days after operation,but it was still higher than that before operation(P<0.05).It returned to the preoperative level at the 3 days after surgery.It continued to declined at 1 week and 2 weeks after operation,but there was no significant difference compared with the preoperative and 1week postoperative(P>0.05).Comparing between groups,there were significant differences at 1 day and 2 days after ablation(P<0.05)and there was no difference at 3 days,1 week and 2 weeks after ablation and preoperative(P>0.05).2.3 c Tn I:In RFCA group,1 day after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),It was downward trend at 2 days,3 days and 1week after surgery.It returned to the preoperative level at the 1 week after surgery.It continued to declined at 2 weeks after operation,the difference with preoperative was statistically significant(P<0.05).In CBCA group,1 day after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),It was downward trend at 2 days,3 days and 1week after surgery.It returned to the preoperative level at the 1 week after surgery.It continued to declined at 2 weeks after operation,the difference with preoperative was statistically significant(P<0.05).Comparing between groups,there were significant differences at 1 day and 2 days after ablation(P<0.05)and there was no difference at3 days,1 week and 2 weeks after ablation and preoperative(P>0.05).3 Comparison of recurrence rate between RFCA group and CBCA group Following up recurrence of AF,22 patients had clinical recurrences of AF,in witch 2 patients had both early recurrence and late recurrence,including early recurrence in 10 patients and late recurrence in14 patients in RFCA group.5 patients had clinical recurrences of AF,including early recurrence in 3 patients and late recurrence in 2patients in CBCA group.The AF early and late recurrence rate in RFCA group is higher than CBCA group(P<0.05).4 Relevant analysis of atrial fibrillation recurrence after ablationAccording to Logistic regression analysis,there was no relationship among age,gender,preoperative left atrial diameter and recurrence of atrial fibrillation.Source of energy,postoperative CK,CK-MB,c Tn I peak were associated with the overall recurrence of atrial fibrillation.The recurrence rate of atrial fibrillation of cryoballoon was lower than that of radiofrequency ablation;The higher the peak value of CK,CK-MB and c Tn I after ablation,the lower the recurrence rate of atrial fibrillation.In multivariate analysis,the peak value of CK was significantly correlated with recurrence of atrial fibrillation(P<0.05).Further analyzing of the relationship between early and late recurrence of atrial fibrillation after ablation and the factors above,source of energy,postoperative CK,CK-MB,c Tn I peak was associated with recurrence of atrial fibrillation(P<0.05).Conclusions:1 There was mild myocardial injury after radiofrequency ablation and cryoablation group,CK,CK-MB,c Tn I reach the peak at 1 day after ablation and recover to the normal level at 3 days,2-3 days,1 week after ablation respectively.2 The CK,CKMB,and c Tn I were significantly higher in the cryoablation group than those in the radiofrequency ablation group at 1day and 2 days after operation.3 Postoperative CK,CK-MB,c Tn I peak have no correlation with short-term and long-term recurrence of atrial fibrillation,it had a certain correlation with the overall recurrence of atrial fibrillation.The higher the peak value,the lower the recurrence rate of atrial fibrillation.The peak of CK has the strongest predictive ability of AF recurrence. |
PDF Full Text Request