Detection of thrombogenicity induced by radiofrequency catheter ablation

ABSTRACT

The aim of this study is to determine the independent and incremental procoagidant effect of RF ablation by assessing biochemical marker of thrombogenicity. The biochemical markers used in this study is direct measures of fibrinolysis [d-dimer, DD]. This study is a comparative clinical trial that was conducted in EP laboratory of National Heart Institute. This study included forty patients are divided into twenty patients referred for radio-frequency transcatheter ablation in right side of the heart [patients with AVNRT] and twenty patients with accessory pathway in the left side of heart with supraventricular tachycardia. Patients with history of recent electrophysiological study [EPS], malignant disease, history of embolic events, recent surgery or trauma, history of atrial fibrillation, active thrombotic process, renal failure, cerebrovascular stroke or previously identified coagulopathy or thrombocytopenia were excluded from the study. No medications affecting the function of the platelets and coagulation system was administered in any of the study subjects. Any antiarrhythmic drugs were withdrawn prior to study. All patients included in the study were subjected to full history taking, thorough clinical examination, resting 12-lead electrocardiogram, transthoracic echocardiography, CBC, FT, PTT, routine laboratory investigations. D-dimer measurement was measured immediately after insertion of the venous sheaths, before introduction of the electrode catheters, on completion of EPS and mapping, before production of the first RF ablation [post-EPS measurements], after completion of the RF procedure [post-RF measurements], before sheath removal and at 36 to 40 hours later and before discharge from the hospital. The D-dimer level in all the studied patients increased significantly after EPS and in spite of that it decrease before discharge it is still significantly higher than that of the baseline level [P < 0.001]. In patients with AVNRT [right sided] and in patients with AP [left sided] the D-dimer level increased significantly after EPS and it decrease before discharge but it was still significantly higher than that of the baseline level [P < 0.001]. Comparison between left and right sided ablation showed no significant difference in the D-dimer level [P > 0.05]. Both right and left sided EPS ablation was associated with an increase in the D-dimer level and this increase continued until discharge