Catheter Ablation for AF Improves Global Thrombotic Profile and Enhances Fibrinolysis

Overview

Journal J Thromb Thrombolysis

Specialty Cardiology & Vascular Diseases

Date 2017 Sep 19

PMID 28921408

Citations 5

Authors

Maria Niespialowska-Steuden

Vias Markides

Mohamed Farag

David Jones

Wajid Hussain

Tom Wong

Diana A Gorog

Affiliations

Soon will be listed here.

Abstract

Patients with atrial fibrillation (AF) are at increased risk of thrombotic events despite oral anticoagulation (OAC). Radiofrequency catheter ablation (RFCA) can restore and maintain sinus rhythm (SR) in patients with AF. To assess whether RFCA improves thrombotic status. 80 patients (71% male, 64 ± 12y) with recently diagnosed AF, on OAC and scheduled to undergo RFCA or DC cardioversion (DCCV) were recruited. Thrombotic status was assessed using the point-of-care global thrombosis test (GTT), before, and 4-6 weeks after DCCV and 3 months after RFCA. The GTT first measures the time taken for occlusive thrombus formation (occlusion time, OT), while the second phase of the test measures the time taken to spontaneously dissolve this clot through endogenous thrombolysis (lysis time, LT). 3 months after RFCA, there was a significant reduction in LT (1994s [1560; 2475] vs. 1477s [1015; 1878]) in those who maintained SR, but not in those who reverted to AF. At follow-up, LT was longer in those in AF compared to those in SR (AF 2966s [2038; 3879] vs. SR 1477s [1015; 1878]). RFCA resulted in no change in OT value, irrespective of rhythm outcome. Similarly, there was no change in OT or LT in response to DCCV, irrespective of whether SR was restored. Successful restoration and maintenance of SR following RFCA of AF is associated with improved global thrombotic status with enhanced fibrinolysis. Larger studies are required to confirm these early results and investigate whether improved thrombotic status translates into fewer thromboembolic events.

Citing Articles

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References

Vaidya K, Arnott C, Russell A, Masson P, Sy R, Patel S . Pulmonary Vein Isolation Compared to Rate Control in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis. Heart Lung Circ. 2015; 24(8):744-52. DOI: 10.1016/j.hlc.2015.02.025. View

Farag M, Niespialowska-Steuden M, Okafor O, Artman B, Srinivasan M, Khan A . Relative effects of different non-vitamin K antagonist oral anticoagulants on global thrombotic status in atrial fibrillation. Platelets. 2016; 27(7):687-693. DOI: 10.3109/09537104.2016.1158402. View

Lim H, Schultz C, Dang J, Alasady M, Lau D, Brooks A . Time course of inflammation, myocardial injury, and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation. Circ Arrhythm Electrophysiol. 2014; 7(1):83-9. DOI: 10.1161/CIRCEP.113.000876. View

Akar J, Jeske W, Wilber D . Acute onset human atrial fibrillation is associated with local cardiac platelet activation and endothelial dysfunction. J Am Coll Cardiol. 2008; 51(18):1790-3. DOI: 10.1016/j.jacc.2007.11.083. View

Kamath S, Blann A, Chin B, Lip G . A prospective randomized trial of aspirin-clopidogrel combination therapy and dose-adjusted warfarin on indices of thrombogenesis and platelet activation in atrial fibrillation. J Am Coll Cardiol. 2002; 40(3):484-90. DOI: 10.1016/s0735-1097(02)01984-8. View

Guo Y, Lip G, Apostolakis S . Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012; 60(22):2263-70. DOI: 10.1016/j.jacc.2012.04.063. View

Lim H, Willoughby S, Schultz C, Chakrabarty A, Alasady M, Lau D . Successful catheter ablation decreases platelet activation and improves endothelial function in patients with atrial fibrillation. Heart Rhythm. 2014; 11(11):1912-8. DOI: 10.1016/j.hrthm.2014.07.030. View

Khoo C, Krishnamoorthy S, Lim H, Lip G . Atrial fibrillation, arrhythmia burden and thrombogenesis. Int J Cardiol. 2011; 157(3):318-23. DOI: 10.1016/j.ijcard.2011.06.088. View

Saraf S, Christopoulos C, Ben Salha I, Stott D, Gorog D . Impaired endogenous thrombolysis in acute coronary syndrome patients predicts cardiovascular death and nonfatal myocardial infarction. J Am Coll Cardiol. 2010; 55(19):2107-15. DOI: 10.1016/j.jacc.2010.01.033. View

10.

Rotter M, Jais P, Vergnes M, Nurden P, Takahashi Y, Sanders P . Decline in C-reactive protein after successful ablation of long-lasting persistent atrial fibrillation. J Am Coll Cardiol. 2006; 47(6):1231-3. DOI: 10.1016/j.jacc.2005.12.038. View

11.

Corley S, Epstein A, DiMarco J, Domanski M, Geller N, Greene H . Relationships between sinus rhythm, treatment, and survival in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study. Circulation. 2004; 109(12):1509-13. DOI: 10.1161/01.CIR.0000121736.16643.11. View

12.

Bunch T, Crandall B, Weiss J, May H, Bair T, Osborn J . Patients treated with catheter ablation for atrial fibrillation have long-term rates of death, stroke, and dementia similar to patients without atrial fibrillation. J Cardiovasc Electrophysiol. 2011; 22(8):839-45. DOI: 10.1111/j.1540-8167.2011.02035.x. View

13.

Noseworthy P, Kapa S, Deshmukh A, Madhavan M, Van Houten H, Haas L . Risk of stroke after catheter ablation versus cardioversion for atrial fibrillation: A propensity-matched study of 24,244 patients. Heart Rhythm. 2015; 12(6):1154-61. DOI: 10.1016/j.hrthm.2015.02.020. View

14.

Willems S, Khairy P, Andrade J, Hoffmann B, Levesque S, Verma A . Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ Arrhythm Electrophysiol. 2016; 9(8). DOI: 10.1161/CIRCEP.115.003909. View

15.

Kornej J, Lip G, Bollmann A . Reduction of stroke and mortality in patients with atrial fibrillation by catheter ablation? Finally, tackling the hard endpoints. Europace. 2012; 15(5):620-2. DOI: 10.1093/europace/eus389. View

16.

Calkins H, Kuck K, Cappato R, Brugada J, Camm A, Chen S . 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012; 14(4):528-606. DOI: 10.1093/europace/eus027. View

17.

Okafor O, Gorog D . Endogenous Fibrinolysis: An Important Mediator of Thrombus Formation and Cardiovascular Risk. J Am Coll Cardiol. 2015; 65(16):1683-1699. DOI: 10.1016/j.jacc.2015.02.040. View

18.

Wyse D, Waldo A, DiMarco J, Domanski M, Rosenberg Y, Schron E . A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347(23):1825-33. DOI: 10.1056/NEJMoa021328. View

19.

Camm A, Lip G, De Caterina R, Savelieva I, Atar D, Hohnloser S . 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012; 33(21):2719-47. DOI: 10.1093/eurheartj/ehs253. View

20.

Marin F, Roldan V, Lip G . Fibrinolytic function and atrial fibrillation. Thromb Res. 2003; 109(5-6):233-40. DOI: 10.1016/s0049-3848(03)00259-7. View