Dissertation > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Arrhythmia

Evaluation of Myocardial Damage Induced by Radiofrequency Catheter Ablation and the Comparison of Myocardial Damage between Using Saline-irrigated Ablation Catheter and Conventional Ablation Catheter

Author ChenFengYuan
Tutor ZhuWenQing
School Fudan University
Course Internal Medicine
Keywords Radiofrequency ablation Myocardial injury Cardiac enzymes cTnT hs-CRP Cold saline infusion radiofrequency ablation bulk of
CLC R541.7
Type Master's thesis
Year 2011
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Objective: To observe the line radiofrequency ablation (radiofrequency catheter ablation, RFCA) in patients with preoperative, postoperative serum creatine phosphate kinase (CK), creatine kinase isoenzyme (CK-MB) and cardiac troponin T (cardiac troponin T, cTnT), lactate dehydrogenase (LDH), NT-proBNP, hs-CRP changes explore RFCA surgery cause myocardial damage clinical evaluation and ablation factors, as well as to compare the the RFCA surgery in general radiofrequency ablation of the bulk of radiofrequency ablation with cold saline infusion bulk of myocardial injury. Methods: A prospective analysis of radiofrequency ablation in patients with 231 cases, 115 cases of male, female 114 cases, the average age (47.1 ± 14.9) years, divided into focal ablation radiofrequency ablation type (FL, n = 194) and line ablation group (LL, n = 37), before surgery, after 4 hours, 10 hours, 24 hours to extract blood specimens sent for follow-up CK, CK-MB, cTnT, LDH NT-proBNP, hs-CRP. Record total time of ablation, ablation and discharge times, the cumulative discharge energy. Comparing RFCA perioperative myocardial injury indicators, changes in inflammatory markers. Analysis of relevant indicators and ablation time, energy, and discharge times, and compare different ablation position caused by the differences of myocardial injury; subgroup analysis of patients with focal ablation, according to the bulk of the type the RFCA surgery using radiofrequency ablation cold saline infusion radiofrequency ablation of the bulk of group (n = 34) cases, and the bulk of ordinary radiofrequency ablation group (n = 160) patients were compared before and after surgery, follow-up serum enzyme and of cTnT compare the two different types of RF ablation bulk of the extent of myocardial injury the impact. Results: In all cases surgical procedure had no complications, two groups RFCA preoperative cTnT were in the normal range (lt; 0.01 ng) after surgery were significantly higher (FL: 0.26 ± 0.36ng/ml median : 0.15, LL: 0.35 ± 0.22ng/ml median: 0.28, both P lt; 0.001), LL group compared with FL increased significantly (P lt; 0.001), sensitivity (FL: 91.8% VSLL: 100% ). FL group before and after surgery, CK, CK-MB level change has a statistically significant difference (P lt; 0.001) and LL group had no significant difference (P = 0.695,0.803). Patients with abnormal CK levels was no significant difference (P = 0.118), and CK-MB postoperative elevated level FL group than in the LL group (17.3 ± 8.7U / L VS 14.9 ± 4.8U / L, P = 0.023 ), patients with abnormal CK-MB sensitivity (FL: 14.4% VSLL: 0%, P = 0.029); For the two groups before and after surgery LDH and changes in inflammatory markers hs-CRP in both groups were significantly increased (P lt; 0.001), and the higher the degree of LL group than the FL group (P lt; 0.001), postoperative indicators sensitivity (LDH: FL: 5.7% VS LL: 24.3%, P = 0.001), (hs -CRP: FL: 11.8% VS LL: 64.5%, P lt; 0.001); There was no significant change in the two groups before and after surgery cardiac function indicators NT-proBNP (P = 0.695, P = 0.326), but LL group NT-proBNP based values ??and postoperative levels were significantly higher than the FL group (P lt; 0.001); ablation time, the cumulative discharge energy observations showed a significant correlation, which cTnT the highest degree of correlation (r = 0.536, r = 0.482, P are lt; 0.001), number of discharges and CK-MB, cTnT, LDH was significantly correlated, but the degree of correlation is not high. Comparing different ablation site of myocardial injury, found the ventricular wall discharge postoperative CK-MB and cTnT peak levels of the most obvious, and discharge accumulated energy and there is a significant correlation. Followed by atrial fibrillation / atrial flutter / atrial tachycardia ablation, the dual pathway slow pathway ablation increased minimally; The relatively ordinary RF ablation bulk of cold saline infusion radiofrequency ablation of the bulk of the impact of myocardial injury: preoperative CK, CK-MB, cTnT baseline values ??no significant differences between the two sets of cardiac enzymes after surgery, cTnT were significantly increased (P lt; 0.001), cold saline infusion bulk of group rose more obvious difference between the two groups was statistically significant (P lt; 0.05) Conclusion : myocardial damage caused by radiofrequency ablation for local minor damage, cTnT detect highly sensitive indicator of the damage; acute myocardial infarction, cTnT peak ahead of radiofrequency ablation induced myocardial injury, lower peak characteristics. Myocardial injury caused by atrial fibrillation / atrial flutter / PVCs / VT more the indicator is more difficult to identify myocardial ischemia alone; RF ablation RF postoperative cTnT peak ablation of time, the cumulative energy discharge times have RF ablation catheter can be a significant positive correlation; ablation caused significant myocardial injury in heart wall, followed by atrial wall, the lowest level of myocardial injury caused by atrioventricular valve ring ablation; relative to the ordinary temperature-controlled RF ablation catheter cold saline infusion produce more myocardial injury.

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