Comparative Determination and Monitoring of Biomarkers of Necrosis and Myocardial Remodeling between Radiofrequency Ablation and Cryoablation

Authors

  • DIANA HERNÁNDEZ-ROMERO Ph.D.,

    1. Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author
  • FRANCISCO MARÍN M.D., Ph.D.,

    Corresponding author
    1. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    • Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    Search for more papers by this author
  • VANESSA ROLDÁN M.D., Ph.D.,

    1. Servicio de Hematología, Hospital Universitario Morales Meseguer, Universidad de Murcia, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author
  • PABLO PEÑAFIEL M.D.,

    1. Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author
  • JUAN ANTONIO VILCHEZ B.Sc. Pharm.,

    1. Servicio de Análisis Clínicos, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author
  • ESTEBAN ORENES-PIÑERO Ph.D.,

    1. Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author
  • JOSÉ ANTONIO GINER M.D.,

    1. Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    Search for more papers by this author
  • MARIANO VALDÉS M.D., Ph.D.,

    1. Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author
  • ARCADIO GARCÍA-ALBEROLA M.D., Ph.D.

    1. Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
    2. Instituto Murciano de Investigaciones Biomédicas, IMIB, Murcia, Spain
    Search for more papers by this author

  • Disclosures: Dr. Hernández-Romero holds a “Sara Borrell” postdoctoral position funded by the Instituto de Salud Carlos III. Dr. Orenes-Piñero holds a postdoctoral position funded by the Fundación para la Formación e Investigación Sanitarias de la Región de Murcia (FFIS). JA Vílchez holds a “Rio-Hortega” research-training position funded by the Instituto de Salud Carlos III.

Address for reprints: Francisco Marín, M.D., Ph.D., Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Ctra Madrid-Cartagena s/n, Murcia 30120, Spain. Fax 0034 968369662; e-mail: fcomarino@hotmail.com

Abstract

Background

Biomarkers of necrosis and inflammation have been found raised after radiofrequency ablation (RF). There is scarce information on biomarkers’ behavior after cryoablation. Our aim was to study biomarkers of necrosis, inflammation, and interstitial remodeling after two different approaches: RF versus cryoablation.

Methods

We studied 22 consecutive patients with atrial flutter who underwent RF (10) or cryoablation (12). All patients underwent electrophysiological study and subsequent ablation. Peripheral samples were collected before the procedure, immediately after, the following day, 3 days, 1 week, 1 month, and 2 months after ablation. Samples were assayed for biomarkers of inflammation (high sensitive C-reactive protein [hs-CRP]) and tissue remodeling (C-propeptide of type I procollagen [CICP], matrix metalloproteinase 2 [MMP-2], matrix metalloproteinase 9 [MMP-9], and metallopeptidase inhibitor 1 [TIMP-1]). We also determined biomarkers of tissue necrosis (creatine kinase [CK], its MB isoenzyme, cardiac troponin I [TnI], and troponin T (TnT)] in samples obtained immediately after ablation, 6 hours postablation, and 12 hours postablation.

Results

Bidirectional isthmus block was achieved in all patients. We found significantly higher levels of CK, CK-MB, and TnI after cryoablation compared to RF ablation for all timing samples. These necrosis biomarkers showed significant differences depending on the time (all P < 0.001), and the interaction between the time and the used ablation approach (P = 0.005, P < 0.001, and P < 0.001, respectively). For patients who undergoing RF ablation, MMP-2 showed the greatest changes depending on the interaction between time and number of applications (P = 0.041), whereas for patients who undergoing cryoablation, CK was the most relevant biomarker depending on the interaction between time and number of applications (P = 0.006).

Conclusions

We show higher levels of necrosis and myocardial injury biomarker after cryoablation versus RF. However, we found higher remodeling processes after RF. Our data support previous publications showing different lesion formation in cryoablation and RF.

(PACE 2013; 36:31–36)

Ancillary