ALFIO STUTO SEAL WHEALTH TEAM, SIRACUSA, ITALY CARDIAC MARKERS AFTER RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION (CAMARAAF) ALFIO STUTO SEAL WHEALTH TEAM, SIRACUSA, ITALY

INTRODUCTION This study may be a pacemaker for further investigations to emphasize that relatively simple measurements can become paramount in the follow-up after atrial fibrillation (AF) ablation.

OBJECTIVES 1) to evaluate the extent of cardiac markers (CM) release after circumferential pulmonary vein ablation (CPVA)  for AF and 2) to assess whether exists any correlation between the extent of myocardial injury revealed by CM changes and AF recurrences and/or left atrium tachycardia (AT) occurrence.

METHODS Were enrolled 161 consecutive pts undergoing  CPVA following Pappone approch. CM measurements were collected before and after the procedure every 6 hours up to 18 hrs. The trans-telephonic ECG monitoring was daily performed after delivery. The follow-up duration was 13 +/- 3,9 months.

CHARACTERISTICS OF THE STUDY POPULATION Age (years) 59.6 +/- 9.6 Gender (M/F) 118/43 Heart Failure 9 Paroxysmal atrial fibrillation (group PAF) (n) 92 Persistent atrial fibrillation (group PsAF) (n) 31 Chronic atrial fibrillation (group CAF) 38 Duration of atrial fibrillation (years) in group PAF 5.8 +/- 4.9 Duration of atrial fibrillation (years) in group PsAF 7.5 +/- 6.2 Duration of atrial fibrillation (years) in group CAF 8.6 +/- 7.0

RESULTS (1) Ablation  was successful in all pts and there were not any major complication. At the end of the follow-up were in sinus rhythm (SR) 128/161 (79,5 %) pts. The mean time of AT occurrence was 9.07 +/- 4.59 months and the mean time of AF recurrence was 7.3 +/- 3.57 months. Ablation  was successful in all pts and there were not any major complication. At the end of the follow-up were in sinus rhythm (SR) 128/161 (79,5 %) pts. The mean time of AT occurrence was 9.07 +/- 4.59 months and the mean time of AF recurrence was 7.3 +/- 3.57 months. In all pts Cardiac troponin I release begins earlier than those usually founded in the setting of ischemic heart disease, as the ablation creates an immediate myocardial necrosis. The rate of increase is faster up to 6th hours  and slower from 6th to 18th hours.  The analysis of variance between the three groups  (AF recurrence, AT occurrence, SR persistence) detect a significant difference of cTrn I released after RF ablation (F = 5.57; P = 0.005). Concerning more specifically the relation between the extent of the cTrn I release and the rhythm outcome: all pts in to whom AF recurred present a cTrnI increase < 4 ng/ml and the risk of AT occurrence was higher for  cTrn I release > 4.5 ng/mL.

According to the rhythm outcome the patients population had been divided in three groups AF recurrence AT occurrence SR persistence Age (years) 59 +/- 9.9 59.4 +/- 8.09 59.7 +/- 9.7 Gender (M/F) 16/4 12/1 90/38 Patients (n) 20 13 128 LAD preablation (mm) 44.3 +/- 6.39 37.0 +/- 2.7 42.0 +/- 5.4 LAD 6 months after ablation (mm) 46.2 +/- 6.3 37.5 +/- 2.37 40.6 +/- 3.64 Cardiac Troponin I basal (ng/ml) 0.05 +/- 0.02 0.04 +/- 0.01 0.04 +/- 0.03 Cardiac Troponin I 6th hours 1.36 +/- 0.55 3.07 +/- 1.05 2.50 +/- 1.49 Cardiac Troponin I 18th hours 2.42 +/- 0.61 4.90 +/- 1.66 3.42 +/- 1.83 According to the rhythm outcome the patients population had been subdivided in three groups (AF recurrence, AT occurrence, SR persistence) and for each group are respectively shown the left atrium diameters (LAD), the basal values (mean +/- SD) of cardiac troponin I and myoglobin, and the extent of its release after ablation.

RESULTS (2) The analysis of variance between the three groups  (AF recurrence, AT occurrence, SR persistence) detect a significant difference of cTrn I released after RF ablation (F = 5.57; P = 0.005). All pts in to whom AF recurred present a cTrnI increase < 4 ng/ml and the risk of AT occurrence was higher for  cTrn I release > 4.5 ng/mL. AF reccurrence: Below 4 ng/ml; AT occurrence: above 4.5 ng/ml

Odds ratio for AF recurrence with cTrn I release up to 3 Odds ratio for AF recurrence with cTrn I release up to 3.5 ng/mL and cTrn I release from 3.51 to 4.0 ng/mL Odds Ratio for cTrn I up to 3.5 ng/mL Odds Ratio for cTrn I from 3.51 to 4 ng/mL   AF NON AF + 18 70 88 2 72 74 - 71 73 69 87 20 141 161 cTrn I = cardiac troponin I; AF = atrial fibrillation Odds Ratio = 9.129 Odds Ratio = 0.106 (C.I. to 95%: 2.041 -40.819 ) (C.I. to 95%: 0.024 -0.476 )  Chi square =9.939 with 1 df Chi square =10.296 with 1 df  P = 0.002 P = 0.001

Odds ratio for AT occurrence with cTrn I release up to 4 Odds ratio for AT occurrence with cTrn I release up to 4.0 ng/mL and cTrn I release from >4.5 ng/mL Odds Ratio for cTrn I up to 4.0 ng/mL Odds Ratio for cTrn I > 4.5 ng/mL   AT NON AT + 4 109 113 6 19 25 - 9 39 48 7 129 136 13 148 161 Odds Ratio = 0.159 Odds Ratio = 5.820 (C.I. to 95%: 0.046 – 0.546) (C.I. to 95%: 1.767 – 19.169) Chi square = 8.551 with 1 df Chi square = 7.732 with 1 df P = 0.003 P = 0.005

CONCLUSION 1 The extent of cTrnI release following the ablation procedure was directly related to the risk of AT and strongly inversely related to AF recurrence supporting the equation: “more extent of cTrnI release = minus AF recurrence”, as testified by our results: “cTrnI > 4 ng/ml = none AF recurrence”. 

CONCLUSION 2 This study may be a pacemaker for further investigations to emphasize that relatively simple measurements can become paramount in the follow-up after atrial fibrillation (AF) ablation.

Tanks for Your attention Ognina Siracusa Ognina Siracusa