Cor Vasa 2018, 60(3):e281-e286 | DOI: 10.1016/j.crvasa.2017.09.002

Asymptomatic damage of central nervous system defined by excess level of protein S-100B in patients undergoing the radiofrequency ablation of ventricular tachycardia

Eva Šušková^*, Otakar Jiravský, Radek Neuwirth, Jan Chovančík, Marian Branny

Kardiocentrum, Nemocnice Podlesí, a.s., Třinec, Česká republika

Aim: Evaluation of the effect of radiofrequency catheter ablation of ventricular arrhythmias on asymptomatic central nervous system evaluation with the help S-100B protein. Furthermore, identification of factors predicting elevation of S-100B protein level after ablation.

Methods: Consecutive patients undergoing RFA for ventricular arrhythmias between 11/2015 and 8/2016. Protein S-100B was evaluated before the procedure, immediately after the procedure, in 8 and 24 h after the procedure. In the case of the excess values of the S-100B protein within 24 h after computed tomography (CT) of CNS supplementation and neurological examination.
Set of patients: Twenty-three patients, of which there were 19 men and 4 women aged 62 ± 8 years. Coronary artery disease with a scar after myocardial infarction in 18 patients (78%), 2 patients with dilated cardiomyopathy, 2 patients with idiopathic ventricular tachycardia, 1 patient with non-compact cardiomyopathy.
Ejection fraction of left ventricle was 29 ± 8%. All patients with implantable cardioverter defibrillator. Three patients (13%) underwent RFA by combined endo-epicardial approach. In 5 patients (22%) the surgery was performed in general anesthesia.

Results: At least one excess value of S-100B protein was identified in 10 patients (43%). After 24 h, the cut off value of the protein S-100B was exceeded in 3 patients (13%). Even in one of these patients, we did not see acute changes on CT of CNS or by neurological examination. Surgery duration, ablation time, necessity for defibrillation during the surgery, intensity of anticoagulation during the surgery were without statistically significant influence on elevation of S-100B protein levels.
A group of patients with S-100B elevation had statistically significantly worse renal functions represented by serum creatinine level (127 ± 41 vs 100 ± 25 mmol/l, p = 0.02). As another factor that statistically significantly predicted the postablation elevation of the protein S-100B the stage of heart failure measured by the levels of NT-proBNP (4417 vs 1634 ng/ l, p = 0.05) was shown. A statistically significant effect on the elevation of S-100B protein in our set was the use of total anesthesia with sevoflurane (p = 0.03).

Conclusion: The elevation of the S-100B protein after catheter ablation for ventricular arrhythmias is relatively common in our set. We did not identify any macroscopic changes on CT of CNS even by neurological examination.
The level of renal insufficiency, the progression of cardiac failure, and the use of inhaled anesthesia with sevoflurane correlate with the amount of S-100B as the biomarker of asymptomatic disability of CNS in patients receiving radiofrequency catheter ablation for ventricular arrhythmias.

Keywords: Catheter ablation; Computed tomography; S-100B; Stroke; Ventricular arrhythmia

Received: June 4, 2017; Revised: August 18, 2017; Accepted: September 16, 2017; Published: June 1, 2018  Show citation