Myocardial injury during radiofrequency and cryoablation of typical atrial flutter.
PURPOSE
Cardiac enzyme elevation after radiofrequency (RF) catheter ablation of atrial flutter (AFL) is common. Some studies found that cryoablation (CRYO) of AFL, compared to RF, is associated with higher levels of troponin, a finding that may indicate CRYO causes a greater amount of myocardial injury than RF. However, other investigations found no significant differences between troponin levels after CRYO versus RF. We have in a randomized study compared the post-procedural troponin I levels in RF and CRYO and the possible relation to procedural outcome and complications.


METHODS
We randomized 153 patients with cavotricuspid isthmus (CTI)-dependent AFL to CRYO or RF (78 CRYO; 75 RF). RF was performed with a 3.5-mm open-irrigated-tip catheter, and CRYO was performed with an 8-mm-tip catheter. Troponin I levels were measured before and 6 h after ablation.


RESULTS
Acute procedural success was achieved in 71/75 patients in the RF and in 72/78 patients in the CRYO. Troponin I levels were significantly elevated in both groups (baseline 0.012, 6th hour 0.35 ng/ml; p < 0.001). Troponin I levels were similar for RF and CRYO. Troponin I levels were higher in patients with acute failure compared to patients with acute success (0.48 ± 0.4 and 0.34 ± 0.16 ng/ml, p = 0.029); however, there was no difference between patients with or without late recurrence. There were no major complications in any group.


CONCLUSION
RF and CRYO for CTI-dependent AFL resulted in similar amounts of procedural myocardial injury. Troponin I levels had no prognostic value for late recurrence of AFL and there were no complications related to high troponin I levels.
['Saygi|Serkan|S|', 'Drca|Nikola|N|', 'Insulander|Per|P|', 'Schwieler|Jonas|J|', 'Jensen-Urstad|Mats|M|', 'Bastani|Hamid|H|']
D000368:Aged D001282:Atrial Flutter D015415:Biomarkers D017115:Catheter Ablation D003452:Cryosurgery D005260:Female D006335:Heart Injuries D006801:Humans D015994:Incidence D008297:Male D011183:Postoperative Complications D011379:Prognosis D012008:Recurrence D018570:Risk Assessment D016037:Single-Blind Method D013548:Sweden D016896:Treatment Outcome D019210:Troponin I
Cryoablation Atrial flutter Troponin I RF ablation