Inflammation, Myocardial Injury and Prothrombotic Response Following Catheter Ablation for Atrial Fibrillation

Abstract

Background: Inflammation has been linked to the genesis of atrial fibrillation (AF). The specific time-course of inflammation, myocardial injury and prothrombotic markers following radiofrequency (RF) ablation for AF has not been documented.
Methods: Ninety consecutive patients undergoing RF ablation for AF were recruited prospectively. Clinical and procedural details were recorded. High-sensitivity CRP (hs-CRP), Troponin-T, creatine kinase-MB (CKMB), fibrinogen and D-Dimer were measured at baseline, 1, 2, 3-days, 1-week and 1-month post-ablation. AF recurrence was documented at 3-days, 1, 3 and 6-months follow-up.
Results: Hs-CRP peaked at day 3 (44.29±37.37 vs. 2.57±2.16 mg/L, p<0.05) post-ablation compared to baseline. Troponin-T (1.61±1.07 vs. 0.05±0.08 µg/L, p<0.05) and CKMB (10.65±5.10 vs. 3.21±1.20 µg/L, p<0.05) peaked at day 1 post-procedure. Fibrinogen (4.71±1.42 vs. 3.11±0.61 g/L, p<0.05) and D-Dimer (0.58±0.46 vs. 0.30±0.18 FEU, p<0.05) levels were significantly elevated at 1-week post-procedure. Hs-CRP elevation correlated with Troponin-T (rs=0.35, p<0.02) and fibrinogen (rs=0.59, p<0.01) elevation. Hs-CRP, Troponin-T and fibrinogen elevation predicted AF recurrence within 3 days post-procedure (p<0.05), but not recurrence at 3 and 6-months.
Conclusion: Patients undergoing RF ablation for AF exhibit an inflammatory response and myocardial injury within the first few days post-ablation. Increased inflammatory response predicts immediate AF recurrence. Prothrombotic markers are elevated one week post-ablation and may explain the increased thrombotic risk post-AF ablation. Targeting the inflammatory response during this timeframe could prevent early recurrences of AF.