Cargando…

Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation

This randomized study aims to compare the left atrial (LA) lesion size, function, and tissue damage following pulmonary vein isolation (PVI) by high-power short-duration (HPSD) radiofrequency (RF) and second-generation cryoballoon (CB2) ablation. We enrolled 40 patients with paroxysmal atrial fibril...

Descripción completa

Detalles Bibliográficos
Autores principales: Kassa, Krisztian Istvan, Nagy, Zsofia, Simkovits, Daniel, Kis, Zsuzsanna, Ferenci, Tamas, Som, Zoltan, Foldesi, Csaba, Kardos, Attila
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604661/
https://www.ncbi.nlm.nih.gov/pubmed/36286279
http://dx.doi.org/10.3390/jcdd9100327
_version_ 1784817870508654592
author Kassa, Krisztian Istvan
Nagy, Zsofia
Simkovits, Daniel
Kis, Zsuzsanna
Ferenci, Tamas
Som, Zoltan
Foldesi, Csaba
Kardos, Attila
author_facet Kassa, Krisztian Istvan
Nagy, Zsofia
Simkovits, Daniel
Kis, Zsuzsanna
Ferenci, Tamas
Som, Zoltan
Foldesi, Csaba
Kardos, Attila
author_sort Kassa, Krisztian Istvan
collection PubMed
description This randomized study aims to compare the left atrial (LA) lesion size, function, and tissue damage following pulmonary vein isolation (PVI) by high-power short-duration (HPSD) radiofrequency (RF) and second-generation cryoballoon (CB2) ablation. We enrolled 40 patients with paroxysmal atrial fibrillation who underwent PVI by HPSD RF (n = 21) or CB2 (n = 19). Every patient underwent LA CT angiography and transthoracic echocardiography (TTE) to assess the LA anatomy and function. Biomarker levels (hs-cTnT, hs-CRP, LDH) were compared pre- and post-procedurally. Pre- and post-ablation high-density mapping (HDM) was performed. The isolation area was defined under 0.2 mV bipolar voltage (low voltage area, LVA). We calculated the post-PVI LVA/LA surface ratio using LA CT-HDM merge images. At 3-month follow-up, TTE was performed to assess the changes in LA function. Post-ablation hs-cTnT level was significantly higher in the RF group (RF: 1249 ± 469 ng/L, CB2: 995 ± 280 ng/L, p = 0.024). Post-PVI hs-CRP (RF: 9.53 ± 10.30 mg/L, CB2: 12.36 ± 5.76 mg/L, p = 0.034) and LDH levels (RF: 349.9 ± 65.6 U/L, CB2: 451.6 ± 91.3 U/L, p < 0.001) were significantly higher following CB2 ablation. Post-PVI LVA/LA surface ratios were 8.37 ± 6.42% in the RF group and 13.58 ± 8.92% in the CB2 group (p = 0.022). LA function did not change significantly after the PVI procedure. Our data indicate that second-generation cryoballoon ablation produces a significantly larger LA lesion size compared to “point-by-point” HPSD radiofrequency. Both techniques preserve LA function. The myocardial component of tissue loss appears to be higher using HPSD radiofrequency ablation, with less collateral damage.
format Online
Article
Text
id pubmed-9604661
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-96046612022-10-27 Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation Kassa, Krisztian Istvan Nagy, Zsofia Simkovits, Daniel Kis, Zsuzsanna Ferenci, Tamas Som, Zoltan Foldesi, Csaba Kardos, Attila J Cardiovasc Dev Dis Article This randomized study aims to compare the left atrial (LA) lesion size, function, and tissue damage following pulmonary vein isolation (PVI) by high-power short-duration (HPSD) radiofrequency (RF) and second-generation cryoballoon (CB2) ablation. We enrolled 40 patients with paroxysmal atrial fibrillation who underwent PVI by HPSD RF (n = 21) or CB2 (n = 19). Every patient underwent LA CT angiography and transthoracic echocardiography (TTE) to assess the LA anatomy and function. Biomarker levels (hs-cTnT, hs-CRP, LDH) were compared pre- and post-procedurally. Pre- and post-ablation high-density mapping (HDM) was performed. The isolation area was defined under 0.2 mV bipolar voltage (low voltage area, LVA). We calculated the post-PVI LVA/LA surface ratio using LA CT-HDM merge images. At 3-month follow-up, TTE was performed to assess the changes in LA function. Post-ablation hs-cTnT level was significantly higher in the RF group (RF: 1249 ± 469 ng/L, CB2: 995 ± 280 ng/L, p = 0.024). Post-PVI hs-CRP (RF: 9.53 ± 10.30 mg/L, CB2: 12.36 ± 5.76 mg/L, p = 0.034) and LDH levels (RF: 349.9 ± 65.6 U/L, CB2: 451.6 ± 91.3 U/L, p < 0.001) were significantly higher following CB2 ablation. Post-PVI LVA/LA surface ratios were 8.37 ± 6.42% in the RF group and 13.58 ± 8.92% in the CB2 group (p = 0.022). LA function did not change significantly after the PVI procedure. Our data indicate that second-generation cryoballoon ablation produces a significantly larger LA lesion size compared to “point-by-point” HPSD radiofrequency. Both techniques preserve LA function. The myocardial component of tissue loss appears to be higher using HPSD radiofrequency ablation, with less collateral damage. MDPI 2022-09-28 /pmc/articles/PMC9604661/ /pubmed/36286279 http://dx.doi.org/10.3390/jcdd9100327 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kassa, Krisztian Istvan
Nagy, Zsofia
Simkovits, Daniel
Kis, Zsuzsanna
Ferenci, Tamas
Som, Zoltan
Foldesi, Csaba
Kardos, Attila
Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation
title Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation
title_full Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation
title_fullStr Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation
title_full_unstemmed Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation
title_short Evaluation of Isolation Area, Myocardial Injury and Left Atrial Function Following High-Power Short-Duration Radiofrequency or Second-Generation Cryoballoon Ablation for Atrial Fibrillation
title_sort evaluation of isolation area, myocardial injury and left atrial function following high-power short-duration radiofrequency or second-generation cryoballoon ablation for atrial fibrillation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604661/
https://www.ncbi.nlm.nih.gov/pubmed/36286279
http://dx.doi.org/10.3390/jcdd9100327
work_keys_str_mv AT kassakrisztianistvan evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT nagyzsofia evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT simkovitsdaniel evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT kiszsuzsanna evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT ferencitamas evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT somzoltan evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT foldesicsaba evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation
AT kardosattila evaluationofisolationareamyocardialinjuryandleftatrialfunctionfollowinghighpowershortdurationradiofrequencyorsecondgenerationcryoballoonablationforatrialfibrillation