Abstract
Aims To identify intracardiac hemostasis or fibrinolysis abnormalities, which are associated with atrial fibrillation (AF) and increase the risk of thromboembolism. Patients and Methods Patient group consisted of 24 patients with AF and control group included 14 individuals with other supraventricular tachycardia undergoing transcatheter radiofrequency ablation. Blood samples were drawn from the femoral vein (FV), left atrium (LA), and left atrial appendage (LAA) before the ablation procedure. Fibrinogen, factor VIII (FVIII) and factor XIII activity, von Willebrand factor (VWF) antigen, thrombin-antithrombin (TAT) complex, quantitative fibrin monomer (FM), plasminogen, α2-plasmin inhibitor, plasmin-α2-antiplasmin (PAP) complex, PAI-1 activity, and D-dimer were measured from all samples. Results Levels of FVIII and VWF were significantly elevated in the FV and LA of AF patients as compared to controls. TAT complex, FM, PAP complex, and D-dimer levels were significantly elevated in the LA as compared to FV samples in case of both groups, indicating a temporary thrombotic risk associated with the catheterization procedure. Conclusions None of the investigated hemostasis or fibrinolysis parameters showed significant intracardiac alterations in AF patients as compared to non-AF controls. AF patients have elevated FVIII and VWF levels, most likely due to endothelial damage, presenting at both intracardiac and systemic level.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with a high risk of mortality and morbidity from stroke and thromboembolism [1]
In this study we aimed to identify local hemostasis and fibrinolysis abnormalities, which are associated with AF and increase the risk of thromboembolism
8 AF patients and 4 controls had to be excluded from the study population due to technical problems arising during the intracardiac blood drawing procedure
Summary
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia associated with a high risk of mortality and morbidity from stroke and thromboembolism [1]. Several risk factors (age, hypertension, diabetes mellitus, etc.) predispose to stroke in patients with AF, it has been controversial whether the arrhythmia itself leads to hypercoagulability [3,4,5]. It is a well-known fact that anticoagulation therapy reduces the risk of ischemic stroke in AF patients by two-thirds [6]. Most studies have focused on the relation of AF-associated thromboembolism with various endothelial damage markers, prothrombotic or inflammatory factors, and plasma markers of platelet activation [4, 8, 11, 12].
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