| 김숙경¹, 박희남¹ ,박재형¹ ,남명현² ,문지영¹,장진근¹ ,최종일¹ ,임홍의¹ ,조윤정² ,김영훈¹ |
Background It has been reported that vascular injury triggers the mobilization of CD34+ endothelial progenitor cells. We hypothesized that titrated cardiac injury by radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) recruit CD34+ cells.
Method and Results Thirty one patients (20 male, 17 paroxysmal AF, 56±12 years old) with AF who underwent RFCA were included. We performed NavX guided left atrial (LA) bilateral antral ablation with or without linear ablation by irrigation tip catheter (30W, 20~25 mL/min) and measured the duration of RF energy delivery. CD34+ cell counts, stromal cell derived factor-1 (SDF-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were evaluated before, immediately after, 24 hours after, and 10 days after RFCA, respectively. 3D voltage maps generated by NavX were compared with % increase of CD34+ cells. Results: 1. Compared with baseline, CD34+ cells were significantly increased immediately after (53.7±80.8%, p<0.001) and 24 hour after (61.8±133.7%, p=0.01), and 10 days after RFCA (44.8±101.7%, p<0.02). 2. % increase of CD34+ cells immediately after RFCA was correlated with time duration of RF energy delivery (R=0.4,p<0.05), and was higher in patients with persistent AF (85.4±94.0%) than in those with paroxysmal AF (21.4±54.9%, p<0.05). 3. The LA voltage (R=-0.63, p<0.02) and its spatial heterogeneity (R=-0.59, p<0.05) had negative correlation with the % increase of CD34+ cells immediately after RFCA. 4. TIMP-1 increased at 24 hours (1.0±0.3ng/mL to 1.3±0.4ng/mL, p<0.02) and on 10 days (1.2±0.5ng/mL, p<0.05) after RFCA, and SDF-1 decreased at 24 hours (2.5±0.5ng/mL to 1.8±0.4ng/mL, p<0.01) and on 10 days (2.2±0.4ng/mL, p<0.05) after RFCA, respectively. SDF-1 immediately after RFCA (R=0.48, p<0.01) and 24 hour (R=0.59, p<0.01) were correlated with % increase of CD34+ cells.
Conclusion Titrated cardiac injury by RFCA of AF mobilizes the bone marrow derived CD34+ cells to the peripheral blood. The mobilization of CD34+ cells was correlated with duration of RF energy delivery, LA voltage, and the level of SDF-1, and was significantly noted in patients with persistent AF.
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