Coagulation alterations in treating arrhythmias with radiofrequency ablation.

OBJECTIVE: To determine an influence of radiofrequency ablation on changes in coagulation system. MATERIAL AND METHODS: We investigated 30 patients with cardiac arrhythmias. Platelet aggregation, fibrinogen and D-dimer level were analyzed before, right after, 24 and 72 h after radiofrequency ablation. Platelet aggregation was explored in whole blood and platelet-rich plasma using adenosine diphosphate (ADP), epinephrine, and collagen for induction. RESULTS: Platelet aggregation induced by ADP and collagen in whole blood plasma increased significantly (P<0.01) (by 45% and 43%, respectively) in 24 h after radiofrequency ablation and remained increased in 72 h after radiofrequency ablation (by 11% and 35%, respectively) (P<0.01) as compared with baseline results. Spontaneous aggregation of platelet-rich plasma as well as ADP- and collagen-induced platelet aggregation tended to decrease right after radiofrequency ablation. Epinephrine-induced platelet aggregation significantly decreased by 17.5% after radiofrequency ablation (P<0.01) and started to increase in 24 h after radiofrequency ablation. In 72 h after radiofrequency ablation, platelet aggregation induced by different agonists increased by 7-45% significantly (P<0.05), and values were higher than baseline ones. Fibrinogen level after radiofrequency ablation did not differ from that of the baseline (3.08+/-0.7 g/L), but D-dimer level increased significantly (from 0.39+/-0.3 to 1.29+/-2.4 mg/L, P<0.01). In 24 h after radiofrequency ablation, an increase in fibrinogen level and a decrease in D-dimer level were found. Fibrinogen level increased to 3.32+/-0.6 g/L significantly in 72 h after radiofrequency ablation (P<0.05). Meanwhile, D-dimer concentration decreased to 0.78+/-0.8 mg/L, but it was still significantly higher (P<0.05) than the baseline value. CONCLUSION: Despite diminished platelet aggregation and increased D-dimer level right after radiofrequency ablation, a risk of thrombosis increased in the next few days after radiofrequency ablation.

Influence of radiofrequency catheter ablation on platelet aggregation.

The objective of this article was to find out how radiofrequency catheter ablation (RFA) influences platelet aggregation (PA), and the dependence on the total energy (TE) of RFA used and the cause of arrhythmia. We investigated 97 patients. PA was analyzed before, after, and in 24 hours after RFA. ADP- and epinephrine-induced PA significantly decreased after RFA by 5% and 8.9% (P < .001), respectively, and increased in 24 hours close to baseline. PA induced by ADP and collagen did not radically depend on the TE. Epinephrine-induced PA decreased after RFA by 0%, 8% (P < .05), and 16.9% (P < .01) in groups of patients where the TEs used were <4000 J, 4000 to 15,000 J, and >15,000 J, respectively. There were no significant differences in PA between groups based on the cause of arrhythmia. ADP- and epinephrine-induced PA significantly decreased after RFA and returned close to baseline in 24 hours. Epinephrine-induced PA was inversely associated with the TE used for RFA.

[Successful treatment of degenerative critical aortic stenosis at stage of valvular cardiomyopathy]. / Sekmingas kritines degeneracines aortos stenozes gydymas issivyscius voztuvinei kardiomiopatijai.

Degenerative aortic stenosis and mitral annulus calcification are the most common valvular abnormalities in elderly population. The incidence of these abnormalities has increased due to increased life expectancy. In recent years, new diagnostic techniques have improved the accuracy of diagnosis of valvular heart disease, however, cases of advanced critical aortic stenosis with valvular cardiomyopathy and severe heart failure still occur. A clinical case of critical degenerative aortic stenosis and mitral annulus calcinosis, mitral stenosis and regurgitation, subsequently significantly decreased ejection fraction (15%) accompanied by valvular cardiomyopathy and severe congestive heart failure is described. Ischemic heart disease was excluded. Cardiosurgery including implantation of aortic and mitral bioprosthesis and tricuspid annuloplasty was performed after intensive medical treatment and improvement of heart failure symptoms. After follow-up of six months, a 76-year-old female patient has just symptoms of mild left-ventricular dysfunction corresponding to New York Heart Association functional class II.

Alterations of platelet aggregation while treating cardiac arrhythmias with radiofrequency ablation.

OBJECTIVE: To find out if radiofrequency ablation as method of treatment of cardiac arrhythmia influences platelet aggregation and if intensity of this process depends on the number of radiofrequency ablation episodes for one patient. MATERIAL AND METHODS: We analyzed platelet aggregation before, right after and in 24 hours after radiofrequency ablation in whole blood and platelet rich plasma in 39 cases with cardiac arrhythmias. Adenosine diphosphate and adrenaline were used for aggregation induction. Three groups of patients were formed based on the number of radiofrequency ablation episodes: A-- <10, B--10-20, C-- >20 for one patient. RESULTS: We detected a decrease in spontaneous, adenosine diphosphate and adrenaline induced platelet aggregation in plasma right after radiofrequency ablation, and also the same tendency was noted in adenosine diphosphate induced aggregation in whole blood. In 24 hours after radiofrequency ablation platelet aggregation tended to return to pre-radiofrequency ablation levels. Based on the number of radiofrequency ablation episodes we detected significant changes in spontaneous and adrenaline-induced aggregation in plasma. In group A adrenaline induced aggregation after radiofrequency ablation increased by 0.4%, in group B it decreased by 15.7% and in group C it decreased by 19.4% from pre-radiofrequency ablation level (p<0.05, between groups A and C). Spontaneous platelet aggregation after radiofrequency ablation decreased in group A 41.9%, in group B--20.8% and in group C--18.4% from pre-radiofrequency ablation level (p<0.05 between groups A and C). The greater decrease in adenosine diphosphate induced aggregation in plasma and in whole blood was detected in the group with larger number of radiofrequency ablation episodes. CONCLUSIONS: This study found that platelet aggregation decreased in plasma and in whole blood after radiofrequency ablation. And this alteration was significant in groups B and C, when the number of radiofrequency ablation episodes were >10. In 24 hours platelet aggregation increased again to pre- radiofrequency ablation level.