Temporal dynamics of myocardial injury biomarkers during cellular electroporation: analysis of different pulsed-field ablation technologies versus radiofrequency ablation in atrial fibrillation

Abstract Background Previous studies have demonstrated that cardiac biomarkers of myocardial injury increase following both radiofrequency (RF) ablation and non-thermal pulsed-field ablation (PFA) based on cellular electroporation for atrial fibrillation (AF). However, a comprehensive comparison of the peri-procedural temporal dynamics of biomarker release, particularly across different PFA technologies, has not yet been conducted. Purpose This study aimed to compare acute myocardial injury by assessing variations in cardiac troponin I (TnI, ng/L), creatine kinase-MB (CK-MB, mg/dL), and myoglobin (MY, ng/mL) following pulmonary vein isolation (PVI) performed with different technologies: Farapulse PFA (PFA-FAR), Varipulse PFA (PFA-VAR), and RF ablation. Methods 186 patients undergoing AF ablation with PVI were prospectively enrolled, 79 treated with RF, 69 with PFA-FAR and 38 with PFA-VAR. PFA was delivered by a protocol-directed PVI using 2kV for PFA-FAR or 1.8 kV for PFA-VAR; during RF ablation, circular lesions were carried out at the antrum of each PV at 40W. Pre- and post-procedure samples of TnI, CK-MB and MY values were collected before PFA ablation and at 3h, 24h and 48h after ablation. Data are reported as medianIQ range. Results All patients exhibited TnI, CK-MB and MY values in the normal range and baseline values were homogeneous between PFA-FAR, PFA-VAR and RF groups. Biomarker levels significantly increased from baseline to 3 hours post-procedure, followed by a recovery trend at 24 and 48 hours, with significant differences observed between groups at each time point. PFA-FAR was associated with the highest biomarker elevation, while PFA-VAR exhibited an intermediate trend between PFA-FAR and RF. By 48 hours, biomarker levels were comparable between PFA-FAR and PFA-VAR. Temporal trends are depicted in Figure 1. PVI was achieved in all patients (100%) using only PFA or RF. No major procedure-related adverse events were reported in both groups, no sign of acute kidney injury or haemolysis were reported. Conclusion These findings indicate that TnI, CK-MB, and MY levels rise following PVI with both PFA technologies and RF. However, cellular electroporation via Farapulse PFA resulted in a greater biomarker increase compared to Varipulse PFA and RF, with Varipulse PFA demonstrating an intermediate pattern.