Skip to main content

Advertisement

SpringerLink
Log in

Markers of oxidative stress after ablation of atrial fibrillation are associated with inflammation, delivered radiofrequency energy and early recurrence of atrial fibrillation

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

The role of oxidative stress after radiofrequency ablation of atrial fibrillation (AF) has not yet been well characterized. We sought to evaluate the time course of biomarkers of oxidative stress and inflammation after AF ablation and their association with clinical variables.

Methods

Thirty consecutive patients (57.9 ± 1.7 years, 63% males) with paroxysmal AF underwent pulmonary vein isolation and ablation of complex fractionated atrial electrograms. Biomarkers were determined in blood samples before ablation and 6 h, 1, 2, 7, 30, 90 and 180 days post-ablation.

Results

The pro-oxidant enzyme myeloperoxidase and oxidized low-density lipoprotein reflecting oxidant damage of lipoproteins increased 2.9 ± 0.2-fold and 1.2 ± 0.1-fold, respectively, and were significantly up-regulated until day 2 post-ablation. The anti-oxidant enzyme copper/zinc superoxide dismutase did not change significantly. Inflammatory markers significantly increased (high-sensitivity C-reactive protein (hs-CRP): 41 ± 8-fold; interleukin-6: 4.4 ± 0.7-fold) for 7 and 2 days, respectively. The increase of myeloperoxidase and hs-CRP was interrelated and both predicted early recurrence of AF within the first post-ablation week (both p < 0.05). The increase of both markers was associated with the amount of delivered radiofrequency energy (p < 0.05). The up-regulation of hs-CRP correlated with troponin T (p = 0.008), while myeloperoxidase and troponin T were borderline associated (p = 0.054). However, the oxidative and inflammatory responses did not predict long-term ablation outcome (p > 0.05).

Conclusions

Markers of oxidative stress showed a significant up-regulation during the first 2 days after AF ablation. Their up-regulation was linked to inflammation, delivered radiofrequency energy, and early recurrence of AF, but did not predict long-term ablation outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Calkins H, Brugada J, Packer DL et al (2007) HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 4:816–861

    Article  PubMed  Google Scholar 

  2. Parihar A, Parihar MS, Milner S et al (2008) Oxidative stress and anti-oxidative mobilization in burn injury. Burns 34:6–17

    Article  PubMed  Google Scholar 

  3. Schindhelm RK, van der Zwan LP, Teerlink T et al (2009) Myeloperoxidase: a useful biomarker for cardiovascular disease risk stratification? Clin Chem 55:1462–1470

    Article  PubMed  CAS  Google Scholar 

  4. Tsimikas S, Bergmark C, Beyer RW et al (2003) Temporal increases in plasma markers of oxidized low-density lipoprotein strongly reflect the presence of acute coronary syndromes. J Am Coll Cardiol 41:360–370

    Article  PubMed  CAS  Google Scholar 

  5. Dehne MG, Sablotzki A, Hoffmann A et al (2002) Alterations of acute phase reaction and cytokine production in patients following severe burn injury. Burns 28:535–542

    Article  PubMed  Google Scholar 

  6. Ziakas A, Gavrilidis S, Giannoglou G et al (2006) In-hospital and long-term prognostic value of fibrinogen, CRP, and IL-6 levels in patients with acute myocardial infarction treated with thrombolysis. Angiology 57:283–293

    Article  PubMed  CAS  Google Scholar 

  7. Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340:448–454

    Article  PubMed  CAS  Google Scholar 

  8. Debrunner M, Schuiki E, Minder E et al (2008) Proinflammatory cytokines in acute myocardial infarction with and without cardiogenic shock. Clin Res Cardiol 97:298–305

    Article  PubMed  CAS  Google Scholar 

  9. Steinvil A, Berliner S, Shapira I et al (2010) Time to rheology in acute myocardial infarction: inflammation and erythrocyte aggregation as a consequence and not necessarily as precursors of the disease. Clin Res Cardiol 99:651–656

    Article  PubMed  Google Scholar 

  10. Huang CX, Liu Y, Xia WF et al (2009) Oxidative stress: a possible pathogenesis of atrial fibrillation. Med Hypotheses 72:466–467

    Article  PubMed  CAS  Google Scholar 

  11. Boos CJ, Anderson RA, Lip GY (2006) Is atrial fibrillation an inflammatory disorder? Eur Heart J 27:136–149

    Article  PubMed  Google Scholar 

  12. Koyama T, Tada H, Sekiguchi Y et al (2010) Prevention of atrial fibrillation recurrence with corticosteroids after radiofrequency catheter ablation a randomized controlled trial. J Am Coll Cardiol 56:1463–1472

    Article  PubMed  Google Scholar 

  13. Saitoh D, Shirani KZ, Cioffi WG et al (2001) Changes in the tissue and plasma superoxide dismutase (SOD) levels in a burned rat model. Tohoku J Exp Med 193:27–36

    Article  PubMed  CAS  Google Scholar 

  14. Hosnuter M, Gurel A, Babuccu O et al (2004) The effect of CAPE on lipid peroxidation and nitric oxide levels in the plasma of rats following thermal injury. Burns 30:121–125

    Article  PubMed  Google Scholar 

  15. Tsimikas S (2006) Oxidative biomarkers in the diagnosis and prognosis of cardiovascular disease. Am J Cardiol 98:9P–17P

    Article  PubMed  CAS  Google Scholar 

  16. Avlan D, Taskinlar H, Tamer L et al (2005) Protective effect of trapidil against oxidative organ damage in burn injury. Burns 31:859–865

    Article  PubMed  Google Scholar 

  17. Horiuchi M, Tsutsui M, Tasaki H et al (2004) Upregulation of vascular extracellular superoxide dismutase in patients with acute coronary syndromes. Arterioscler Thromb Vasc Biol 24:106–111

    Article  PubMed  CAS  Google Scholar 

  18. Miettinen JA, Ylitalo K, Hedberg P et al (2011) Effects of intracoronary injection of autologous bone marrow-derived stem cells on natriuretic peptides and inflammatory markers in patients with acute ST-elevation myocardial infarction. Clin Res Cardiol 100:317–325

    Article  PubMed  CAS  Google Scholar 

  19. Meisinger C, Heier M, von Scheidt W et al (2010) Admission C-reactive protein and short- as well as long-term mortality in diabetic versus non-diabetic patients with incident myocardial infarction. Clin Res Cardiol 99:817–823

    Article  PubMed  CAS  Google Scholar 

  20. Kuck KH, Ernst S, Dorwarth U et al (2007) Guidelines for catheter ablation. Clin Res Cardiol 96:833–849

    Article  PubMed  Google Scholar 

  21. Richter B, Gwechenberger M, Socas A et al (2011) Time course of markers of tissue repair after ablation of atrial fibrillation and their relation to left atrial structural changes and clinical ablation outcome. Int J Cardiol 152:231–236

    Article  PubMed  Google Scholar 

  22. Husser D, Adams V, Piorkowski C et al (2010) Chromosome 4q25 variants and atrial fibrillation recurrence after catheter ablation. J Am Coll Cardiol 55:747–753

    Article  PubMed  CAS  Google Scholar 

  23. Arya A, Hindricks G, Sommer P et al (2010) Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients. Europace 12:173–180

    Article  PubMed  Google Scholar 

  24. Khaper N, Bryan S, Dhingra S et al (2010) Targeting the vicious inflammation-oxidative stress cycle for the management of heart failure. Antioxid Redox Signal 13:1033–1049

    Article  PubMed  CAS  Google Scholar 

  25. Shimano M, Shibata R, Inden Y et al (2009) Reactive oxidative metabolites are associated with atrial conduction disturbance in patients with atrial fibrillation. Heart Rhythm 6:935–940

    Article  PubMed  Google Scholar 

  26. Askari AT, Brennan ML, Zhou X et al (2003) Myeloperoxidase and plasminogen activator inhibitor 1 play a central role in ventricular remodeling after myocardial infarction. J Exp Med 197:615–624

    Article  PubMed  CAS  Google Scholar 

  27. Li YJ, Ding WH, Gao W et al (2004) The protective effect of interleukin-1 receptor antagonist on postischemic reperfused myocardium and its possible mechanism. Zhonghua Yi Xue Za Zhi 84:548–553

    PubMed  CAS  Google Scholar 

  28. Salvayre R, Auge N, Benoist H et al (2002) Oxidized low-density lipoprotein-induced apoptosis. Biochim Biophys Acta 1585:213–221

    PubMed  CAS  Google Scholar 

  29. Usui A, Kato K, Tsuboi H et al (1991) Concentration of Mn-superoxide dismutase in serum in acute myocardial infarction. Clin Chem 37:458–461

    PubMed  CAS  Google Scholar 

  30. Richter B, Derntl M, Marx M et al (2007) Therapy with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and statins: No effect on ablation outcome after ablation of atrial fibrillation. Am Heart J 153:113–119

    Article  PubMed  CAS  Google Scholar 

  31. Stein A, Wessling G, Deisenhofer I et al (2008) Systemic inflammatory changes after pulmonary vein radiofrequency ablation do not alter stem cell mobilization. Europace 10:444–449

    Article  PubMed  Google Scholar 

  32. McCabe JM, Smith LM, Tseng ZH et al (2008) Protracted CRP elevation after atrial fibrillation ablation. Pacing Clin Electrophysiol 31:1146–1151

    Article  PubMed  Google Scholar 

  33. Karpinski L, Plaksej R, Derzhko R et al (2009) Serum levels of interleukin-6, interleukin-10 and C-reactive protein in patients with myocardial infarction treated with primary angioplasty during a 6-month follow-up. Pol Arch Med Wewn 119:115–121

    PubMed  CAS  Google Scholar 

  34. Orn S, Manhenke C, Ueland T et al (2009) C-reactive protein, infarct size, microvascular obstruction, and left-ventricular remodelling following acute myocardial infarction. Eur Heart J 30:1180–1186

    Article  PubMed  CAS  Google Scholar 

  35. Gonon AT, Gourine AV, Middelveld RJ et al (2001) Limitation of infarct size and attenuation of myeloperoxidase activity by an endothelin A receptor antagonist following ischaemia and reperfusion. Basic Res Cardiol 96:454–462

    Article  PubMed  CAS  Google Scholar 

  36. Pintaudi AM, Tesoriere L, D’Arpa N et al (2000) Oxidative stress after moderate to extensive burning in humans. Free Radic Res 33:139–146

    Article  PubMed  CAS  Google Scholar 

  37. Sholter DE, Armstrong PW (2000) Adverse effects of corticosteroids on the cardiovascular system. Can J Cardiol 16:505–511

    PubMed  CAS  Google Scholar 

  38. Al Chekakie MO, Akar JG, Wang F et al (2007) The effects of statins and renin-angiotensin system blockers on atrial fibrillation recurrence following antral pulmonary vein isolation. J Cardiovasc Electrophysiol 18:942–946

    Article  PubMed  Google Scholar 

  39. Hayward RM, Upadhyay GA, Mela T et al (2011) Pulmonary vein isolation with complex fractionated atrial electrogram ablation for paroxysmal and nonparoxysmal atrial fibrillation: A meta-analysis. Heart Rhythm 8:994–1000

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to express gratitude to Christina Zeilinger for reviewing the manuscript. The study was funded by the Medical-Scientific Fund of the Mayor of the City of Vienna (Vienna, Austria). The study was also supported by a research fund provided by Biosense Webster (Diamond Bar, CA, USA).

Conflict of interest

The author Bernhard Richter reports receiving a research fund provided by Biosense Webster. The other authors report no conflicts.

Author information

Authors and Affiliations

  1. Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Bernhard Richter, Marianne Gwechenberger, Ariel Socas, Gerlinde Zorn, Jutta Bergler-Klein, Thomas Binder, Johann Wojta & Heinz D. Gössinger

  2. Department of Pediatric Cardiology, Medical University of Vienna, Vienna, Austria

    Sulaima Albinni & Manfred Marx

Authors
  1. Bernhard Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marianne Gwechenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ariel Socas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gerlinde Zorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sulaima Albinni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manfred Marx
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jutta Bergler-Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas Binder
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Johann Wojta
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Heinz D. Gössinger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bernhard Richter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Richter, B., Gwechenberger, M., Socas, A. et al. Markers of oxidative stress after ablation of atrial fibrillation are associated with inflammation, delivered radiofrequency energy and early recurrence of atrial fibrillation. Clin Res Cardiol 101, 217–225 (2012). https://doi.org/10.1007/s00392-011-0383-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-011-0383-3

Keywords

Search

Navigation