Freeze or burn – platelets do not seem to care! Results from the SPARELIFE-CVD substudy

    Authors

    Keywords

    atrial fibrillation, pulmonary vein isolation, cryoablation, radiofrequency ablation, platelet reactivity

    DOI

    https://doi.org/10.15836/ccar2023.284

    Full Text

    **Introduction**: Pulmonary vein isolation (PVI) is an established procedure to treat atrial fibrillation (Afib) but it increases periinterventional thromboembolic burden (1). Literature provides ambiguous results about ablation effects on different hemostatic markers. The aim of this study was to assess the difference between two used PVI methods (cryoablation and radiofrequency ablation (RFA)) in postinterventional platelet reactivity (PR). **Patients and Methods**: We analyzed PR in 168 consecutive patients undergoing PVI due to Afib in our institution using Multiplate function analyzer. Blood samples for PR measurements were drawn prior to the procedure and the on the following morning. In total, 123 and 45 patients underwent cryoablation and RFA, respectively. There was no difference in demographics and baseline platelet parameters between the groups (**Table 1**). ASPItest, ADPtest and TRAPtest were used as assays for the quantitative in vitro determination of PR triggered by arachidonic acid, adenosine diphosphate and thrombin receptor activating peptide-6, respectively. ### TABLE 1: Baseline patient characteristics. | **Patients’ characteristics** | **Cryoablation (n=123)** | **Radiofrequency ablation (n=45)** | **p** | | --- | --- | --- | --- | | Age, mean years (min-max) | 58.3 (27-77) | 60.8 (45-78) | 0.17 | | Men, n (%) | 89 (72.3) | 27 (60.0) | 0.12 | | BMI, kg/m2, mean (min-max) Paroxysmal Afib, n (%) | 28.36 (22.0-38.2) 100 (81.3) | 28.96 (23.5-37.2) 38 (84.4) | 0.48 0.64 | | Arterial hypertension, n (%) Hyperlipidemia, n (%) | 86 (69.9) 61 (49.6) | 33 (73.3) 21 (46.7) | 0.67 0.74 | | Diabetes mellitus, n (%) Renal dysfunction, n (%) CHA2DS2-VASc, mean (min-max) HAS-BLED, mean (min-max) | 8 (6.5) 12 (9.7) 1.82 (0-6) 0.97 (0-3) | 3 (6.7) 4 (8.9) 1.91 (0-5) 0.82 (0-3) | 0.97 0.86 0.70 0.34 | | Platelets, x109/L, mean (min-max) MPV, fL, mean (min-max) PR before PVI ASPItest, U, mean ADPtest, U, mean TRAPtest, U, mean | 220.1 (108-339) 10.44 (8.2-13.2) 29.3 23.9 35.4 | 222.1 (138-379) 10.25 (8.1-12.4) 32.1 28.9 38.3 | 0.82 0.42 0.66 0.36 0.71 | **Results**: Postprocedurally, PR was significantly lower in both groups after 24 hours. There were no statistically significant differences in PR values between the groups on the next day in all three tests (ASPItest 23U v 25U p=0.75; ADPtest 20U v 25U p=0.24; TRAPtest 29U v 34U p=0.47) (**Figure 1**). FIGURE 1. Platelet reactivity change one day after pulmonary vein isolation. ASPItest - assay for determination of platelet function triggered by arachidonic acid; ADPtest - assay for determination of platelet function triggered by adenosine diphosphate; PVI – pulmonary vein isolation; RFA – radiofrequency ablation; TRAPtest - assay for determination of platelet function triggered by thrombin receptor activating peptide-6 **Conclusion**: Our results show that PR after PVI is lower after 24 hours regardless of the type of ablation. Insignificantly lower PR in cryo group might be due to less myocardial necrosis done with cryo compared to RFA. We hypothesize that the general similarity in PR drop could be predominantly a result of successful restoration of sinus rhythm in both groups which might be the prevailing factor in determining PR level in patients with Afib one day after ablation. These results should be confirmed with studies which would encompass early and late periinterventional PR measurements on a larger cohort of patients. ## Acknowledgments This study was funded by the Croatian Science Foundation.

    Literature

    1. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017 October;14(10):e275–444. https://doi.org/10.1016/j.hrthm.2017.05.012
    Cardiologia Croatica
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    Freeze or burn – platelets do not seem to care! Results from the SPARELIFE-CVD substudy

    Extended Abstract
    Issue11-12
    Published
    Pages284-285
    PDF via DOIhttps://doi.org/10.15836/ccar2023.284
    atrial fibrillation
    pulmonary vein isolation
    cryoablation
    radiofrequency ablation
    platelet reactivity

    Authors

    Petar SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Laura RudeljORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje JurinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran VelagićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor PuljevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure Samardžić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: jure.samardzic@gmail.com

    Full Text

    Introduction: Pulmonary vein isolation (PVI) is an established procedure to treat atrial fibrillation (Afib) but it increases periinterventional thromboembolic burden (1). Literature provides ambiguous results about ablation effects on different hemostatic markers. The aim of this study was to assess the difference between two used PVI methods (cryoablation and radiofrequency ablation (RFA)) in postinterventional platelet reactivity (PR).

    Patients and Methods: We analyzed PR in 168 consecutive patients undergoing PVI due to Afib in our institution using Multiplate function analyzer. Blood samples for PR measurements were drawn prior to the procedure and the on the following morning. In total, 123 and 45 patients underwent cryoablation and RFA, respectively. There was no difference in demographics and baseline platelet parameters between the groups (Table 1). ASPItest, ADPtest and TRAPtest were used as assays for the quantitative in vitro determination of PR triggered by arachidonic acid, adenosine diphosphate and thrombin receptor activating peptide-6, respectively.

    TABLE 1: Baseline patient characteristics.

    Age, mean years (min-max)
    Cryoablation (n=123)
    58.3 (27-77)
    Radiofrequency ablation (n=45)
    60.8 (45-78)
    p
    0.17
    Men, n (%)
    Cryoablation (n=123)
    89 (72.3)
    Radiofrequency ablation (n=45)
    27 (60.0)
    p
    0.12
    BMI, kg/m2, mean (min-max) Paroxysmal Afib, n (%)
    Cryoablation (n=123)
    28.36 (22.0-38.2) 100 (81.3)
    Radiofrequency ablation (n=45)
    28.96 (23.5-37.2) 38 (84.4)
    p
    0.48 0.64
    Arterial hypertension, n (%) Hyperlipidemia, n (%)
    Cryoablation (n=123)
    86 (69.9) 61 (49.6)
    Radiofrequency ablation (n=45)
    33 (73.3) 21 (46.7)
    p
    0.67 0.74
    Diabetes mellitus, n (%) Renal dysfunction, n (%) CHA2DS2-VASc, mean (min-max) HAS-BLED, mean (min-max)
    Cryoablation (n=123)
    8 (6.5) 12 (9.7) 1.82 (0-6) 0.97 (0-3)
    Radiofrequency ablation (n=45)
    3 (6.7) 4 (8.9) 1.91 (0-5) 0.82 (0-3)
    p
    0.97 0.86 0.70 0.34
    Platelets, x109/L, mean (min-max) MPV, fL, mean (min-max) PR before PVI ASPItest, U, mean ADPtest, U, mean TRAPtest, U, mean
    Cryoablation (n=123)
    220.1 (108-339) 10.44 (8.2-13.2) 29.3 23.9 35.4
    Radiofrequency ablation (n=45)
    222.1 (138-379) 10.25 (8.1-12.4) 32.1 28.9 38.3
    p
    0.82 0.42 0.66 0.36 0.71

    Results: Postprocedurally, PR was significantly lower in both groups after 24 hours. There were no statistically significant differences in PR values between the groups on the next day in all three tests (ASPItest 23U v 25U p=0.75; ADPtest 20U v 25U p=0.24; TRAPtest 29U v 34U p=0.47) (Figure 1).

    FIGURE 1. Platelet reactivity change one day after pulmonary vein isolation. ASPItest - assay for determination of platelet function triggered by arachidonic acid; ADPtest - assay for determination of platelet function triggered by adenosine diphosphate; PVI – pulmonary vein isolation; RFA – radiofrequency ablation; TRAPtest - assay for determination of platelet function triggered by thrombin receptor activating peptide-6

    Conclusion: Our results show that PR after PVI is lower after 24 hours regardless of the type of ablation. Insignificantly lower PR in cryo group might be due to less myocardial necrosis done with cryo compared to RFA. We hypothesize that the general similarity in PR drop could be predominantly a result of successful restoration of sinus rhythm in both groups which might be the prevailing factor in determining PR level in patients with Afib one day after ablation. These results should be confirmed with studies which would encompass early and late periinterventional PR measurements on a larger cohort of patients.

    Acknowledgments

    This study was funded by the Croatian Science Foundation.

    Literature

    1. 1.
      Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017 October;14(10):e275–444.DOI