Major determinants of myocardial injury after pulmonary vein isolation with radiofrequency ablation

Abstract

Background: Radiofrequency (RF) current is used as a common energy source to perform pulmonary vein isolation (PVI) in patients with atrial fibrillation. We applied measurements of the blood concentration of cTnI as a surrogate parameter for the injured cell mass.
Aim: To clarify which parameters are major determinants of myocardial injury, estimated by cTnI, after PVI with RF ablation.
Methods: The study population consisted of 82 consecutive patients in whom PVI with RF ablation was performed. In 41 patients, additional linear lesions (LL) were needed. Blood samples were obtained during venous puncture before a procedure and a further one, six and 24 hours after ablation.
Results: Pathological cTnI values were observed in all patients in the first hour and further increased in time. The median of peak cTnI value in the LL group was significantly (p < 0.05) higher than the respective value in patients without LL made: 1.16 (0.85;1.98) and 0.94 (0.65;1.14) ng/mL, respectively. Significantly higher cTnI values (p = 0.043) were observed in patients who maintained sinus rhythm in long term follow-up.
Conclusions: The only independent predictor of myocardial injury after PVI with RF ablation, expressed as an increase in cTnI level, is cumulative energy applied. The larger the myocardial injury, the greater the PVI effectiveness.