Pulsed-field ablation provides faster, safer, and better tissue selectivity with less inflammatory response induced by apoptosis-dominated cell death compared to traditional catheter ablation.
How do different catheter ablation modalities affect inflammatory cell death, structural/electrical remodeling, and atrial fibrillation recurrence?
Pulsed-field ablation may offer superior safety and efficacy in atrial fibrillation treatment by inducing less inflammatory response and favoring apoptosis-dominated cell death.
Atrial fibrillation (AF) poses a serious healthcare burden on society due to its high morbidity and the resulting serious complications such as thrombosis and heart failure. The principle of catheter ablation is to achieve electrical isolation by linear destruction of cardiac tissue, which makes AF a curable disease. Currently, catheter ablation does not have a high long-term success rate. The current academic consensus is that inflammation and fibrosis are central mechanisms in the progression of AF. However, artificially caused inflammatory cell death by catheter ablation may have a significant impact on structural and electrical remodeling, which may affect the long-term prognosis. This review first focused on the inflammatory response induced by apoptosis, necrosis, necroptosis, pyroptosis, ferroptosis and their interaction with arrhythmia. Then, we compared the differences in cell death induced by radiofrequency ablation, cryoballoon ablation and pulsed-field ablation. Finally, we discussed the structural and electrical remodeling caused by inflammation and the association between inflammation and the recurrence of AF after catheter ablation. Collectively, pulsed-field ablation will be a revolutionary innovation with faster, safer, better tissue selectivity and less inflammatory response induced by apoptosis-dominated cell death.
Liu et al. (Tue,) conducted a review in Atrial fibrillation. Catheter ablation (radiofrequency, cryoballoon, pulsed-field) was evaluated. Pulsed-field ablation provides faster, safer, and better tissue selectivity with less inflammatory response induced by apoptosis-dominated cell death compared to traditional catheter ablation.