Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation

Cardiol J. 2014;21(5):516-23. doi: 10.5603/CJ.a2013.0153. Epub 2013 Dec 2.


Background: Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies.

Methods and results: One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 ± 3 h and 43 ± 3 h after ablation. At the first postprocedural sample, cTnI and CK-MB levels were found elevated in all 110 patients with a median value of 2.11 ng/mL and 8.95 ng/mL, respectively. Group B showed cTnI levels increased (median 5.96 ng/mL) compared to other groups (median Group A: 1.72 ng/mL, Group C: 1.54 ng/mL, Group D: 2.0 ng/mL; p < 0.001). Also CK-MB levels resulted higher in cryoablation (median 26.4 ng/mL) compared to other groups (median Group A: 6.40 ng/mL, Group C: 7.15 ng/mL, Group D: 6.50 ng/mL; p < 0.001). No significant association was observed between biomarker levels and recurrences of atrial fibrillation after a mean follow-up of 369 ± 196 days.

Conclusions: Highest markers for myocardial injury were observed in the cryoballoon group. It is possible that a longer delivery energy duration and other factors affecting lesion size resulted in higher amount of cardiac injury in cryoablation. The higher levels of cardiac biomarkers did not translate into a better outcome and its physiologic significance is unknown.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Atrial Fibrillation / blood
  • Atrial Fibrillation / surgery*
  • Biomarkers / blood*
  • Catheter Ablation / adverse effects*
  • Catheter Ablation / methods
  • Creatine Kinase, MB Form / blood
  • Cryosurgery / adverse effects*
  • Cryosurgery / methods
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / blood*
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / etiology
  • Postoperative Complications / blood*
  • Postoperative Complications / diagnosis
  • Prospective Studies
  • Pulmonary Veins / surgery
  • Severity of Illness Index
  • Troponin I / blood
  • Troponin T / blood


  • Biomarkers
  • Troponin I
  • Troponin T
  • Creatine Kinase, MB Form