İncim Şule GÜL, Ömer AKYÜREK, Mustafa KILIÇKAP, Başar CANDEMİR, Canan Işıkay TOGAY, Ali Timuçin ALTN, Demet Menekşe GEREDE, Aynur ACIBUCA, Veysel Kutay VURGUN

Atriyal Fibrilasyon Kateter Ablasyonu YapÖlan Hastalarda Serum Nöron Spesifik Enolaz Düzeylerindeki Değişim

Amaç: Atriyal fibrilasyon (AF) kateter ablasyonu, antiaritmik tedaviye ra?men semptomatik olan hastalar için uygun bir tedavi seçene?idir. Ancak bu iLlem, baLta inme olmak üzere tromboembolik komplikasyonlara yol açabilmektedir. Biz, ablasyon iLlemi sÖrasÖnda ve sonrasÖnda, akut nöronal hasarÖn biyomarkerÖ olarak bilinen serum nöron spesifik enolaz (NSE) düzeylerindeki de?iLimi ölçmeyi amaçladÖk. Gereç ve Yöntem: Paroksismal AF'si olan 43 hastaya radyofrekans ablasyon yöntemi ile pulmoner ven izolasyonu yapÖldÖ. gLlem öncesi ve sonrasÖnda karLÖlaLtÖrmalÖ olarak nörolojik muayeneleri yapÖlan hastalarÖn serum NSE düzeyleri; iLlemden hemen önce, iLlemin sonunda, iLlem bittikten 2 saat, 24 saat ve 48 saat sonrasÖnda ölçülerek de?erlendirildi. Bulgular: HastalarÖn hiçbirinde yeni geliLen nörolojik defisit izlenmedi. Ama NSE seviyeleri 14 hastada üst referans limit olan 17 ng/ml'nin üzerine çÖktÖ ve 33 hastada bazal seviyesine göre %50 artÖL gösterdi. YaL, hipertansiyon, geçirilmiL inme, diyabet, aterosklerotik kalp hastalÖ?Ö varlÖ?Ö, CHA2DS2 VASc skoru [birleLik risk skoru [her biri 1 puan]: konjestif kalp yetmezli?i, hipertansiyon, 75 yaL ve üstü (2 puan), diyabet, inme (2 puan), 65 yaL ve üstü, vasküler hastalÖk, kadÖn cinsiyet] gibi klinik parametreler ve aktive pÖhtÖlaLma zamanÖ, toplam iLlem süresi, elektriksel kardiyoversiyon gibi iLlem iliLkili parametreler NSE seviyesinde artÖLla iliLkili bulunmadÖ. Ama, NSE seviyesi üst referans limitin üstüne yükselen hastalarÖn sol atriyum çaplarÖ daha geniLti ve NSE seviyesinde %50 artÖL izlenen hastalarÖn iLlem sÖrasÖndaki sistolik kan basÖncÖ de?erleri daha düLüktü. Sonuç: Serum NSE seviyeleri AF ablasyonu yapÖlan hastalarÖn büyük kÖsmÖnda artÖL göstermiL ve üçte birinde normalin üst sÖnÖrÖnÖ aLmÖLtÖr. Serum NSE düzeylerindeki artÖL nöronal hasarÖn bir belirteci olarak kabul edilse de AF ablasyonu yapÖlan hastalarda izlenen bu artÖLÖn serebral embolilerle iliLkisini ortaya koymak için daha ileri çalÖLmalara gerek vardÖr

Change of Serum Neuron-Specific Enolase Levels in patients Undergoing Catheter Ablation for Atrial Fibrillation

Aim: Catheter ablation of atrial fibrillation (AF) is a favourable therapeutic option for the treatment of patients, who are symptomatic despite antiarrhythmic medication. However, this procedure may lead to thromboembolic complications, especially stroke. We aimed to measure serum neuron-specific enolase (NSE) levels, which is known as biomarker of acute neuronal injury, during and after the ablation. Materials and Methods: Forty three patients with paroxysmal AF underwent pulmonary vein isolation performed by radiofrequency ablation. A neurological examination was performed pre- and postprocedural period. Serum NSE levels were determined before and at the end of the procedure, at 2, 24 and 48 hours after the procedure. Results: None of the patients developed new neurological deficits. But NSE levels increased after ablation above the upper reference limit of 17 ng/ml in 14 patients; and also 50% increase was observed compared to baseline in 33 patients. No clinical parameters such as age, hypertension, previous history of stroke, diabetes mellitus, atherosclerotic heart disease, CHA2DS2 VASc score FRPSRVLWH ULVN VFRUH SRLQW HDFK FRPSULVLQJ FRQJHVWLYH KHDUW IDLOXUH KSHUWHQVLRQ DJHHDUV SRLQWV GLDEHWHV VWURNH SRLQWV DJHHDUV YDVFXODU GLVHDVH DQG IHPDOH JHQGHU and no procedural parameters such as activated clotting time value, total procedure time, electrical cardioversion were associated with an increased level of NSE. But, patients with increased NSE level above the upper reference limit had larger left atrium and patients with 50% increase in NSE level had lower systolic blood pressure during the procedure. Conclusion: Serum NSE level increased in most of the patients undergoing catheter ablation for AF, also in one third of the patients it exceeded the upper reference limit. Despite increase in NSE is a marker of neuronal injury, clinical importance of this finding should be evaluated in a longitudinal study”

PDF

___

1. Camm AJ, Lip GY, De Caterina R, et al. An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J 2012; 33: 2719-2747.
2. January CT, Wann LS, Alpert JS, et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014; 130: e199-267.
3. Cappato R, Calkins H, Chen SA, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 2010; 3: 32–38.
4. Haeusler KG, Koch L, Herm J, et al. 3 Tesla MRI-detected brain lesions after pulmonary vein isolation for atrial fibrillation: results of the MACPAF study. J Cardiovasc Electrophysiol 2013; 24: 14- 21.
5. Müller P, Halbfass P, Szöllösi A, et al. Impact of periprocedural anticoagulation strategy on the incidence of new-onset silent cerebral events after radiofrequency catheter ablation of atrial fibrillation. J Interv Card Electrophysiol J Interv Card Electrophysiol 2016; 46: 203-211
6. von Barry C, Deneke T, Arentz T, et al. Silent serebral events as a result of left atrial catheter ablation do not cause neuropsychological sequelae—a MRI-controlled multicenter study. J Interv Card Electrophysiol 2015; 43: 217-226.
7. Müller P, Maier J, Dietrich JW, et al. Association between left atrial low-voltage area, serum apoptosis, and fibrosis biomarkers and incidence of silent cerebral events after catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2015; 44: 55-62.
8. Sramko M, Peichl P, Wichterle D, et al. A novel biomarker-based approach for the detection of asymptomatic brain injury during catheter ablation of atrialfibrillation. J Cardiovasc Electrophysiol 2014; 25: 349-354.
9. Wunderlich MT, Ebert AD, Kratz T, et al. Early neurobehavioral outcome after stroke is related to release of neurobiochemical markers of brain damage. Stroke 1999; 30: 1190-1195.
10. Rech TH, Vieira SR, Nagel F, et al. Serum neuron-specific enolase as early predictor of outcome after in-hospital cardiac arrest: a cohort study. Crit Care 2006; 10: R 133.
11. Herrmann M, Ebert AD, Galazky I, et al. Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue. Stroke 2000; 31: 645- 650.
12. Scaglione M, Blandino A, Raimondo C, et al. Impact of ablation catheter irrigation Journal of Ankara University Faculty of Medicine 2017, 70 (3) Aynur AcÖbuca, Veysel Kutay Vurgun, Demet MenekĹe Gerede, Ali Timuçin AltÖn, ĝnci ĸule Gül, BaĹar Candemir, Canan IĹÖkay Togay, Mustafa KÖlÖçkap, Ömer Akyürek 167 design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: results from a pilot study. J Cardiovasc Electrophysiol 2012; 23: 801- 805.
13. Martinek M, Sigmund E, Lemes C, et al. Asymptomatic cerebral lesions during pulmonary vein isolation under uninterrupted oral anticoagulation. Europace 2013; 15: 325-331.
14. Kuwahara T, Takahashi A, Takahashi Y, et al. Prevention of periprocedural ischemic stroke and management of hemorrhagic complications in atrial fibrillation ablation under continuous warfarin administration. J Cardiovasc Electrophysiol 2013; 24: 510-515.
15. Gaita F, Caponi D, Pianelli M, et al. Radiofrequency catheter ablation of atrial fibrillation: a cause of silent thromboembolism? Magnetic resonance imaging assessment of cerebral thromboembolism in patients undergoing ablation of atrial fibrillation. Circulation 2010; 122: 1667-1673.
16. Wissner E, Metzner A, Neuzil P, et al. Asymptomatic brain lesions following laserballoon-based pulmonary vein isolation. Europace 2014; 16: 214-219.
17. Kosiuk J, Kornej J, Bollmann A, et al. Early cerebral thromboembolic complications after radiofrequency catheter ablation of atrial fibrillation: incidence, characteristics, and risk factors. Heart Rhythm 2014; 11: 1934-1940.
18. Srivatsa UN, Danielsen B, Anderson I, et al. Risk predictors of stroke and mortality after ablation for atrial fibrillation: the California experience 2005-2009. Heart Rhythm 2014; 11: 1898-1903.
19. Di Biase L, Burkhardt JD, Santangeli P, et al. Periprocedural stroke and bleeding complications in patients undergoing catheter ablation of atrial fibrillation with different anticoagulation management: results from the Role of Coumadin in Preventing Thromboembolism in Atrial Fibrillation (AF) Patients Undergoing Catheter Ablation (COMPARE) randomized trial. Circulation 2014; 129: 2638-2644.
20. Lickfett L, Hackenbroch M, Lewalter T, et al. Cerebral diffusion-weighted magnetic resonance imaging: a tool to monitor the thrombogenicity of left atrial catheter ablation. J Cardiovasc Electrophysiol 2006; 17: 1-7.
21. Schrickel JW, Lickfett L, Lewalter T, et al. Incidence and predictors of silent cerebral embolism during pulmonary vein catheter ablation for atrial fibrillation. Europace 2010; 12: 52-57.