Influence of thyroid-stimulating hormone on the recurrence after radiofrequency ablation for atrial fibrillation
Atrial fibrillation is one of the most common persistent cardiac arrhythmias and is associated with an increased risk of mortality. Features of the effect of thyroid-stimulating hormone on relapse after radiofrequency ablation in atrial fibrillation.
| Рубрика | Медицина |
| Вид | статья |
| Язык | русский |
| Дата добавления | 18.04.2022 |
| Размер файла | 18,4 K |
Отправить свою хорошую работу в базу знаний просто. Используйте форму, расположенную ниже
Студенты, аспиранты, молодые ученые, использующие базу знаний в своей учебе и работе, будут вам очень благодарны.
Размещено на http://www.allbest.ru
Influence of thyroid-stimulating hormone on the recurrence after radiofrequency ablation for atrial fibrillation
persistent cardiac mortality
M.S. Brynza, N.Yu. Bogun, O.Yu. Shmidt
V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
Abstract
Atrial fibrillation is one of the most common sustained disorders of cardiac rhythm and is associated with an increased risk of mortality, morbidity due to thromboembolic complications, and heart failure. It is impor-tant to highlight that the causative factors are vast. It is well-known that thyroid dysfunction has a proarrhythmic effect and increases the risk of cardiovascular disease. Hyperthyroidism or thyrotoxicosis is recognized to be a baseline risk factor for the development of atrial fibrillation.
However, the role of hypothyroidism in atrial arrhyth- mogenesis is less recognized and not fully understood. At the moment radiofrequency catheter ablation is actively used in the treatment of atrial fibrillation, which in most cases has high efficiency and persistent effect. Despite that, the recurrence of supraventricular tachyarrhythmia can be observed in some patients even after radiofrequency catheter ablation. Patients with a history of hypothyroidism or even high-normal thyroid-stimulating hormone levels are more likely to have a recurrence of supraventricular tachyarrhythmia after radiofrequency catheter abla-tion. Therefore, thyroid-stimulating hormone levels should be determined in patients who have undergone radio-frequency catheter ablation of atrial fibrillation, especially paroxysmal atrial fibrillation. Consequently, it should be noted that the assessment and correction of modifying risk factors before radiofrequency catheter ablation may provide opportunities for future prevention of recurrence of supraventricular paroxysmal arrhythmias, improve the prognosis and overall quality of life in patients of this group. We have demonstrated the clinical case and empha-sized the association of high-normal thyroid-stimulating hormone levels with supraventricular tachyarrhythmia recurrence after radiofrequency catheter ablation for atrial fibrillation.
Keywords: atrial fibrillation; radiofrequency ablation; thyroid-stimulating hormone; recurrence.
Анотація
Вплив тиреотропного гормона на рецидив після радіочастотної абляції при фібриляції передсердь
фібриляція смертність абляція
Бринза М.С., Богун Н.Ю., Шмідт О.Ю.
Харківський національний університет ім. В.Н. Каразіна, м. Харків, Україна
Резюме. Фібриляція передсердь є одним із найпоширені-ших стійких порушень серцевого ритму й пов'язана з під-вищеним ризиком смертності та захворюваності внаслідок тромбоемболічних ускладнень та серцевої недостатності. Важливо підкреслити, що існує величезна кількість факторів розвитку фібриляції передсердь. Загальновідомо, що абера-ції гормонів щитоподібної залози мають проаритмогенний ефект і підвищують ризик серцево-судинних захворювань. Визнано, що гіпертиреоз або тиреотоксикоз є базовим фак-тором ризику щодо розвитку фібриляції передсердь. Проте роль гіпотиреозу в аритмогенезі передсердь менш визнана й до кінця не зрозуміла. Для лікування фібриляції передсердь на даний час активно застосовується радіочастотна катетер- на абляція, яка в більшості випадків має високу ефективність і стійкий ефект. Однак рецидив надшлуночкової тахіаритмії може спостерігатися в деяких пацієнтів навіть після радіо-частотної катетерної абляції. У пацієнтів із гіпотиреозом або навіть високим нормальним рівнем тиреотропного гормона в анамнезі частіше спостерігається рецидив надшлуночкової тахіаритмії після радіочастотної катетерної абляції. Отже, рі-вень тиреотропного гормона слід визначати в пацієнтів, які перенесли радіочастотну катетерну абляцію при фібриляції передсердь, особливо пароксизмальну форму фібриляції пе-редсердь. Слід зазначити, що оцінка й корекція всіх моди-фікуючих факторів ризику перед виконанням радіочастотної катетерної абляції може запобігти рецидивам надшлуночко- вих пароксизмальних аритмій, поліпшити прогноз і загальну якість життя в пацієнтів цієї групи. Ми продемонстрували клінічний випадок і підкреслили зв'язок високих нормаль-них рівнів тиреотропного гормона з рецидивом надшлуноч- кової тахіаритмії після радіочастотної катетерної абляції при фібриляції передсердь.
Ключові слова: фібриляція передсердь; радіочастотна абля-ція; тиреотропний гормон; рецидив
Introduction
Atrial fibrillation (AF) is an increasingly prevalent ar-rhythmia [1]. According to current data, more than 33 mil-lion people worldwide carry the diagnosis of AF [2]. The in-cidence of AF is approximately 2 % in Ukraine and Europe; the prevalence increases with age and this disease is more common in males [3]. AF is associated with an increased risk of mortality, morbidity due to thromboembolic compli-cations, and heart failure (HF) [4, 5]. Ischemic stroke and systemic embolization are major causes of death and di-sability in patients with AF [6, 7]. Catheter radiofrequency ablation (RFA) is a well-es-tablished therapy for patients with AF. It is used to prevent recurrent AF or convert persistent AF to sinus rhythm [8]. First of all, it is achieved by isolation of pulmonary veins (PVs), which usually function as sources of AF, causing pre-mature contractions. Electrical isolation of PVs has been shown to be up to approximately 80 % successful in signifi-cantly reducing the frequency and duration of AF in patients who do not tolerate AF [9--12].
It is well known that thyroid hormonal aberrations, both hyperthyroidism and hypothyroidism, are strongly associated with cardiovascular events. Hyperthyroidism, either overt or subclinical, is known to carry a risk of AF, often inducing HF The role of hypothyroidism is less recog-nized. Subclinical hypothyroidism is defined as a state with elevated serum thyroid-stimulating hormone (TSH) levels with thyroid hormone levels within the normal range, and the thyroid dysfunction is compensated for by the greater stimulation of the elevated TSH level and all increases the risk of cardiovascular events. Some studies suggest a close association of hypothyroidism history with the occurrence of AF in patients. However, there is very little data in the literature on the effect of thyroid hormone levels on the ef-fectiveness of RFA [5, 9, 13--20].
The aim of our clinical case is to emphasize the associa-tion of high-normal TSH levels with atrial tachyarrhythmia recurrence after RFA for AF
Clinical case
A 42-year-old female patient was admitted to the hospi-tal with complaints of fatigue, irregular palpitations which she described as increasingly frequent and prolonged epi-sodes over 6 weeks corresponding to persistent AF despite a trial of bisoprolol. She was admitted to the hospital for diag-nosis and treatment.
Complementary studies revealed normal laboratory re-sults (including thyroid function) apart from ECG, echo-cardiography, and 24-hour Holter monitoring. The thyroid function test showed the following results: TSH values of 3.89 mlU/L (normal values: 0.4--4.0 mlU/L), with triiodo-thyronine of 1.53 ng/ml (normal values: 0.56--1.56 ng/ml) and free T4 of 1.12 ng/dl (normal values: 0.6--1.37 ng/dl). ECG and 24-hour Holter monitoring showed AF An echo-cardiogram showed an enlargement of the left atrium to cm, and the rest of the chambers and ventricular func-tion were normal.
The patient was medicated with oral propafenone and intravenous amiodarone but without effect.
The risk for predicting ischemic stroke was evaluated using the CHA2DS2-VASc score. The patient had 0 points. Nevertheless, she received anticoagulation therapy 3 weeks before RFA, regardless of CHA^S^VASc score. RFA was chosen and complete veins isolation was made during the procedure.
However, the patient underwent repeated RFA within the 90-day blanking period after the initial session because of uncontrollable symptoms of atrial tachyarrhythmia.
Discussion
According to the study published in the Journal of the American Heart Association, hypothyroidism, or an ele-vated TSH may unfavorably affect the outcome of RFA for AF This study is the first which examines the long-term outcome of RFA for AF depending on TSH levels. The major findings of the study were that patients with a high-normal TSH level within the normal TSH range had a significantly higher prevalence of atrial tachyarrhyth-mia recurrence than the lower-TSH quartiles. This trend was more pronounced in the subgroup of paroxysmal AF than in non-paroxysmal AF These findings indicate that patients with a successful AF catheter ablation procedure could be exposed greater to a risk of AF recurrence if their TSH level was even on the high end of the normal range, even more so if they had subclinical or overt hypothyroi-dism [9].
Conclusions
Thus, these findings highlight the relationship be-tween high TSH levels and recurrence of atrial tachyar-rhythmias, and may be an independent predictor of recurrence of atrial tachyarrhythmia after RFA. There-fore, TSH levels should be determined in patients who have undergone RFA for AF, especially paroxysmal AF. It should be noted that an improved understanding of modifying risk factors could provide opportunities for future prevention.
Reference
1. Chung M.K., Refaat M., Shen W.K. et al. Atrial fibrillation. Journal of the American College of Cardiology. 2020. 75(14). 1689-1713.
2. Maraj I., Gonzalez M.D., Naccarelli G.V. Periprocedu- ral Use of Oral Anticoagulation Therapy in Patients Undergoing Atrial Fibrillation Ablation. The Journal of Innovations in Cardi-ac Rhythm Management. 2018. 9(8). 3274-3281. doi: 10.19102/ icrm.2018.090801.
3. Zoni-Berisso M., Lercari F., Carazza T. et al. Epidemiology of atrial fibrillation: European perspective. Clinical Epidemiology. 2014. 6. 213-220. doi: 10.2147/CLEP.S47385.
4. Sankaranarayanan R., Kirkwood G., Visweswariah R., Fox D.J. How does Chronic Atrial Fibrillation Influence Mortality in the Modern Treatment Era. Current Cardiology Reviews. 2015. 11(3). 190-198. doi: 10.2174/1573403x10666140902143020.
5. Jabbar A., Pingitore A., Pearce S.H. et al. Thyroid hormones and cardiovascular disease. Nature Reviews Cardiology. 2017 Jan. 14(1). 39-55. doi: 10.1038/nrcardio.2016.174.
6. Passman R. Catheter ablation to prevent recurrent atrial fibril-lation: Anticoagulation. UpToDate. 2019.
7. Kannel W.B., Wolf P.A., Benjamin E.J., Levy D. Preva-lence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates. The American Journal of Cardiology. 1998 Oct. 82(8A). 2N-9N. doi: 10.1016/s0002- 9149(98)00583-9.
8. Safaei N., Montazerghaem H., Azarfarin R. et al. Radiofre-quency ablation for treatment of atrial fibrillation. BioImpacts. 2011. 1(3). 171-177. doi: 10.5681/bi.2011.023.
9. Morishima I., Okumura K., Morita Y. et al. High-Normal Thyroid-Stimulating Hormone Shows a Potential Causal Associa-tion with Arrhythmia Recurrence After Catheter Ablation of Atrial Fi-brillation. Journal of the American Heart Association. 2018. 7(14). e009158. doi: 10.1161/JAHA.118.009158.
10. Zhang Y., Dedkov E.I., Teplitsky D. et al. Both Hypothy-roidism and Hyperthyroidism Increase Atrial Fibrillation Inducibility in Rats. Circulation: Arrhythmia and Electrophysiology. 2013. 6(5). 952-959. doi: 10.1161/CIRCEP.113.000502.
11. Mujovic N., Marinkovic M., Lenarczyk R. et al. Catheter Ablation of Atrial Fibrillation: An Overview for Clinicians. Advances in Therapy. 2017. 34(8). 1897-1917. doi: 10.1007/s12325-017-0590-z.
12. Link M.S., Haпssaguerre M., Natale A. Ablation of Atrial Fibrillation: Patient Selection, Periprocedural Anticoagulation, Tech-niques, and Preventive Measures After Ablation. Circulation. 2016 Jul. 134(4). 339-352. doi: 10.1161/circulationaha.116.021727.
13. Sharma V. Thyroid hormone levels and risk of atrial fibrilla-tion. American Thyroid Association. 2018. 11 (4). 7.
14. Baumgartner C, da Costa B.R., Collet T.H. et al. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation. Circulation. 2017. 136. 2100-2116.
15. Klein I., Danzi S. Thyroid disease and the heart. Circulation. 2007. 116. 1725-1735.
16. Calkins H, Hindricks G., Cappato R. et al. 2017 HRS/ EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive sum-mary. Journal of Arrhythmia. 2017. 33. 369-409.
17. Walsh J.P., Bremner A.P, Bulsara M.K. et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Ar-chives of Internal Medicine. 2005. 165. 2467-2472.
18. Kim E.J., Lyass A., Wang N. et al. Relation of hypothy-roidism and incident atrial fibrillation (from the Framingham Heart Study). American Heart Journal. 2014. 167. 123-126.
19. Wei S.B., Wang W., Liu N. et al. U-shaped association bet-ween serum free triiodothyronine and recurrence of atrial fibrillation after catheter ablation. Journal of Interventional Cardiac Electro-physiology: an International Journal of Arrhythmias and Pacing. 2018 Apr. 51(3). 263-270. doi: 10.1007/s10840-018-0337-z.
20. Bruere H., Fauchier L., Bernard Brunet A. et al. History of thyroid disorders in relation to clinical outcomes in atrial fibrillation. The American Journal of Medicine. 2015. 128. 30-37.
Размещено на Allbest
...Подобные документы
Acromegaly as an rare syndrome that result when the anterior pituitary gland produces excess growth hormone. Signs and symptoms, etiology and pathogenesis. The complications of acromegaly. Treatment: Hormone therapy, surgery on the pituitary gland.
презентация [827,4 K], добавлен 28.12.2015Testosterone is the primary male sex hormone that is present in both men and women. How to get a test for testosterone correctly. Testosterone in men: the norm and deviation. What diseases involve reduction of testosterone. Too much testosterone.
презентация [498,5 K], добавлен 26.05.2013Factors associated with increased risk of deformities in specialty physician. The most important factor in preventing burnout is likely to be considered meeting the need for self-actualization, which is the central concept of humanistic psychology.
презентация [75,1 K], добавлен 20.10.2014Blood Vessel Wall. Classes of Arteries. Atheromatous plaque. Risk Factors for Atherosclerosis. Age as a risk factor. Factors affecting plasma lipid levels. Additional Risk Factors. Pathogenesis of Atherosclerosis. Components of Atherosclerotic plaque.
презентация [2,1 M], добавлен 20.11.2013Analysis of factors affecting the health and human disease. Determination of the risk factors for health (Genetic Factors, State of the Environment, Medical care, living conditions). A healthy lifestyle is seen as the basis for disease prevention.
презентация [1,8 M], добавлен 24.05.2012The history of plague. The disease. Mortality. Physicians. The physicians of the fourteenth century and the Black Death. Effects of The Black Death: religion, other effects. The Black Death in European architecture as in literature.
реферат [23,1 K], добавлен 23.01.2008Different classification schemes for dementias. His reasons. Risk Factors for Dementia. Dementia is diagnosed by using many methods such as patient's medical and family history, physical exam, neurological evaluations, cognitive and neuropsychological.
презентация [775,8 K], добавлен 10.06.20138 bad habits that reduce youth and life. Effect of nicotine to the brain, nervous system and the associated excess sweating. The composition of tobacco smoke. Closely relation of sport and health. The harm of smoking for women, the human psyche.
презентация [777,7 K], добавлен 07.11.2014Pneumonia is an inflammatory condition of the lung—affecting primarily the microscopic air sacs known as alveoli. The bacterium Streptococcus pneumoniae is a common cause of pneumonia. Symptoms, diagnostics, treatment and prevention of this disease.
презентация [279,8 K], добавлен 12.11.2013Principles and types of screening. Medical equipment used in screening. identify The possible presence of an as-yet-undiagnosed disease in individuals without signs or symptoms. Facilities for diagnosis and treatment. Common screening programmes.
презентация [921,2 K], добавлен 21.02.2016Physical meaning of electron paramagnetic resonance and nuclear magnetic resonance. Splitting of energy levels. Zeeman effect. Spin probe. Device and mechanism of spectrometer and introscopy. The usage of EPR specters, NMR in medico-biological researches.
контрольная работа [153,5 K], добавлен 15.12.2015Risk Factors. The following symptoms may indicate advanced disease. A barium contrast study of the small intestine. Surgical removal is the primary treatment for cancer of the small intestine. The association of small bowel cancer with underlying.
презентация [4,1 M], добавлен 28.04.2014Improvement of antibiotic production. Use of antibiotics in human, veterinary and plant medicine. Genetic manipulation of antibiotic producers. Influence of low molecular compounds. Conservation of microorganisms. Protection of workers and life safety.
дипломная работа [1,2 M], добавлен 12.04.2015Causes of ischemic stroke. Assessment of individual risk for cardiovascular disease in humans. The development in patients of hypertension and coronary heart disease. Treatment in a modern hospital disorders biomarkers of coagulation and fibrinolysis.
статья [14,8 K], добавлен 18.04.2015The pathological process Acute Respiratory Distress Syndrome (ARDS). Specific challenges in mechanical ventilation of patients with ARDS. Causes of ARDS, and differential diagnosis. Treatment strategies and evidence behind them. Most common causes ARDS.
презентация [2,6 M], добавлен 21.05.2015Classification of the resistance. External and internal barnry protecting the human body from pathological factors of the environment. The chemical composition of the blood, its role and significance. Influence the age on individual reactivity progeria.
презентация [4,5 M], добавлен 17.10.2016The concept and the internal structure of the lungs, the main components and their interaction. Functional features of the lungs in the human body, their relationship with other anatomical systems. Existing pathology of respiratory organ and control.
презентация [2,5 M], добавлен 12.02.2015The physiological, hygienic and epidemiological value of water. Diseases associated with water factor. Measures to prevent transmission of infectious diseases through the water. Influence of biological factors on survival of microorganisms in water.
презентация [762,9 K], добавлен 17.05.2016Introduction to the functionality of the most important internal organs. The main causes of supraventricular and ventricular tachycardia. Features of the structure and basic functions of the human heart. The study of the three phases of the heart.
презентация [3,8 M], добавлен 12.05.2013Orderliness (methodical) of the general inspection. The patient's position in bed. Constitution types - set of congenital and acquired the morphological and functional characteristics of the organism. Distinctive features of the constitutional types.
презентация [2,1 M], добавлен 22.02.2015
