Clin Res Cardiol 99, Suppl 1, April 2010
V58 - Safety of Transvenous Pulmonary Vein Isolation for the Treatment of Atrial Fibrillation: A Prospective Randomized Study Comparing Radiofrequency Energy with Cryoenergy
 
C. Herrera Siklódy1, D. Trenk2, C. Stratz2, C. M. Valina2, R. Weber1, J. Minners2, D. Kalusche1, F. Toti3, O. Morel4, T. Arentz1
 
1Rhythmologie, Herzzentrum Bad Krozingen, Bad Krozingen; 2Herz-Zentrum Bad Krozingen, Bad Krozingen; 3Faculté de Médecine, Université de Strasbourg, Strasbourg, Frankreich; 4Cardiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, Frankreich;
 
Background: New transvenous devices using cryoenergy have been recently introduced to perform pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). Experimental data suggested that cryoenergy (CRYO) produced less endothelial disruption and platelet activation than radiofrequency energy (RF), offering therefore safety benefits. We aimed to compare both systems in this regard by measuring for the first time sensitive laboratory markers of cell damage, platelet activation and inflammation in patients after a PVI using either one of those energies.
Methods: Sixty patients with symptomatic drug-resistant AF referred for PVI (56±9 years of age, 48 males. 38 with paroxysmal and 22 with persistent AF) were randomly assigned to undergo the ablation procedure using either an open irrigated tip RF catheter (Thermocool®. Biosense Webster) or a cryoballoon catheter (Arctic front®. Medtronic). The endpoint of ablation was complete bidirectional conduction block. Systemic markers of cell damage (procoagulant microparticles [MP - total MP captured on annexin-V and MP of various cellular origin], troponin T, CK and CK-MB). platelet activation (ADP-induced light transmittance aggregation [LTA], expression of the platelet surface proteins P-selectin [pSEL] and activated GPIIb/IIIa [PAC-1]) and inflammatory response (high sensitive C-reactive protein - hs-CRP) were determined before and 4, 24 and 48 hours  after the procedure.
Results: Procedure time was significantly shorter in patients treated with the cryoballoon (177±30 min versus 200±46 min. p=0.028), but there were no differences in fluoroscopic time, complication rate and success rate. The laboratory safety parameters are summarized for both ablation systems in the enclosed table. Post-procedural increases were observed in Troponin T and hs-CRP, but there were no consistent differences in parameters used for comparative laboratory safety assessment between cryoenergy and radiofrequency energy.
Conclusions: Neither systematic sensitive markers of cell damage, of platelet activation nor of inflammatory response could detect any difference in the safety profile between cryoenergy and RF energy used for transseptal PVI in patients with AF.
 

 

Catheter

Before

4 h after

24 h after

 48 h after
MP annexin-V
RF (M) 		 Thermocool  5.4
[4.4 - 6.8]		  4.4
[2.8 - 6.2]		  7.6
[6.0 - 9.5]		  6.7
[5.9 - 8.4]
 MP annexin-V
Cryo (nM)		  Cryocath  5.6
[4.9 - 6.6]		  6.8
[5.1 - 8.2]*		  8.3
[6.7 - 9.6]		  6.9
[5.6 - 8.4]
 Troponin RF
(ng/ml)		  Thermocool  <0.01  0.89
[0.51 - 1.46]		  1.36
[0.88 - 1.59]		  0.57
[0.46 - 0.63]
 Troponin Cryo
(ng/ml)		  Cryocath <0.01  0.91
[0.73 - 1.23]		  0.93
[0.77 - 1.35]*		  0.64
[0.48 - 0.74]
 LTA ADP 5µM
RF (%)		  Thermocool  59.5
[49.0 - 77.8]		  68.0
[54.3 - 78.5]		  75.0
[62.5 - 86.0]		  78.5
[70.0 - 89.0]
 LTA ADP 5µM
Cryo (%)		  Cryocath  67.5
[50.5 - 79.0]		  66.5
[52.8 - 73.5]		  78.0
[56.0 - 84.0]		  76.0
[67.5 - 89.5]
 pSEL ADP
RF (AU)		  Thermocool  27.5
[21.8 - 31.2]		  26.6
[21.9 - 30.6]		  34.6
[30.7 - 47.2]		  36.5
[31.5 - 44.0]
 pSEL ADP
Cryo (AU)		  Cryocath  25.2
[19.4 - 30.9]		  23.4
[20.5 - 29.9]		  31.7
[28.0 - 37.1]		  33.4
[27.4 - 40.1]
 hs-CRP RF
(mg/dL)		  Thermocool  0.16
[0.16 - 0.23]		  0.20
[0.16 - 0.30]		  1.60
[1.20 - 2.28]		  3.8
[1.80 - 5.70]
 hs-CRP Cryo
(mg/dL)		  Cryocath  0.16
[0.16 - 0.20]		  0.20
[0.16 - 0.35]		  2.05
[1.33 - 3.00]		  1.80
[1.28 - 3.05]*
Median with interquartile range; *p<0.05 Cryo vs. RF by Mann-Whitney test
 
Clin Res Cardiol 99, Suppl 1, April 2010
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-010-1100-3
http://www.abstractserver.de/dgk2010/ft/abstracts/V58.htm