Hemostatic changes before and during electrophysiologic study and radiofrequency catheter ablation

Area of Science:

• Cardiology
• Hematology
• Medical Devices

Background:

• Electrophysiologic study (EPS) and radiofrequency catheter ablation (RFA) are common procedures for treating cardiac arrhythmias.
• Understanding the hemostasis activation during these procedures is crucial for patient safety and management.

Purpose of the Study:

• To investigate specific hemostasis activation markers during EPS with RFA.
• To assess changes in coagulation, fibrinolytic, and platelet activity throughout the procedure.

Main Methods:

• Prospective study of 60 patients undergoing routine EPS with RFA for paroxysmal supraventricular tachycardia.
• Blood samples collected pre-procedure (T0), post-EPS (T1), and 30 minutes post-RFA (T2).
• Measured markers included thrombin-antithrombin III (TAT), D-dimers (DD), plasminogen activator inhibitor type 1 (PAI-1), tissue-type plasminogen activator (t-PA), and circulating platelet aggregates.

Main Results:

• D-dimer levels significantly increased from T0 to T2 (0.24 to 0.59 mg/L).
• Thrombin-antithrombin III levels showed a significant increase at T1 (5.29 to 35.80 μg/L) and decreased by T2.
• Platelet activation was observed from the start of the procedure without significant changes during its course. D-dimer levels correlated with the number of RFA applications.

Conclusions:

• EPS with RFA induces significant activation of the coagulation system.
• The extent of D-dimer elevation is related to the number of radiofrequency energy applications.
• Platelet activation occurs early and persists throughout the procedure, suggesting potential thrombotic risks.