Cryoablation of Atrial Fibrillation in Cardiac Surgery: Outcomes and Myocardial Injury Biomarkers

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• 作者：José ; Martí ; nez-Comendador PhD^?/sup> ;   ; ^{josemmcomendador@gmail.com} ; Mario Castañ ; o PhD^?/sup> ; Ignacio Mosquera MD^&dagger ; ; Jesú ; s Gó ; mez Plana MD^?/sup> ; Javier Gualis PhD^?/sup> ; Carlos Esteban Martí ; n MD^?/sup> ; Pilar Mencí ; a MD^?/sup>
• 关键词：arrhythmia therapy ; cardiopulmonary bypass ; intralesional therapy ; myocardial injury ; ablations ; maze procedures
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：25
• 期：6
• 页码：1030-1035
• 全文大小：601 K

文摘

Objective

Elevations of myocardial injury biomarkers after cardiac surgery without ablation of atrial fibrillation (AF) are related to perioperative myocardial ischemia and associated with an increased risk of mortality and cardiac events. However, there have not been any studies that examined the release of cardiac biomarkers after AF cryoablation procedures with concomitant cardiac surgery. The authors determined the levels of these biomarkers for 2 different procedures involving cryoablation and assessed their clinical implications.

Design

A prospective cohort study with cardiac surgical patients.

Setting

A tertiary care university hospital.

Participants

One hundred fifty-two cardiac surgical patients.

Interventions

Patients underwent 1 of 2 different cryoablation approaches: the modified Cox-Maze (CM) III procedure (n = 63) or the isolated left atrial (LA) maze procedure (n = 89). Plasma levels of cardiac biomarkers were measured at 1, 6, 12, and 24 hours after surgery. Twenty-four-hour Holter monitoring was performed at 1 month and 1 year after surgery.

Measurements and Main Results

Both groups reached very high peak levels of CPK-MB (CM group, 368 ¡À 171.4 ng/mL and LA group, 203 ¡À 86.4 ng/mL) and troponin T (CM, 8 ¡À 4.5 ng/mL and LA, 3.4 ¡À 2.4 ng/mL). The CPK, CPK-MB, and troponin T levels were significantly higher in the modified CM group compared with the LA maze group. In the first 24 hours after surgery, the average CPK-MB and troponin T values were 78.2 ng/mL higher and 2.3 ng/mL higher, respectively, in the CM group compared with the LA group. In both groups, 79 % of the patients remained free of AF at 12 months after surgery.

Conclusions

Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF.