Balloon-in-basket pulsed field ablation with adjunctive posterior wall isolation did not significantly increase systemic biomarker release of inflammation, myocardial injury, or hemolysis compared to pulmonary vein isolation alone in adults undergoing first-time AF ablation.
Observational (n=60)
No
Does adding posterior wall isolation to pulmonary vein isolation using balloon-in-basket pulsed field ablation increase systemic biomarker release of inflammation, myocardial injury, and hemolysis in patients with atrial fibrillation?
Adding posterior wall isolation to pulmonary vein isolation using balloon-in-basket pulsed field ablation does not significantly increase systemic inflammation, myocardial injury, or hemolysis, supporting its biological safety.
p-value: p=No significant difference between groups for all biomarker changes, e.g., Δ troponin T 1154 ng/L vs. 1029 ng/L, p=0.694; Δ CK 217 U/L vs. 197 U/L, p=0.652; Δ CRP 2.7 mg/L vs. 3.4 mg/L, p=0.475; Δ bilirubin 2.4 µmol/L vs. 2.8 µmol/L, p=0.842; Δ creatinine 3.3 µmol/L vs. 9.0 µmol/L, p=0.085
Background A novel balloon-in-basket pulsed field ablation (BiB-PFA) catheter enables efficient pulmonary vein isolation (PVI) and allows posterior wall isolation (PWI) within the same procedure. The incremental biological effect of PWI compared to PVI alone remains uncertain, particularly regarding inflammation, myocardial injury, and hemolysis. Methods In this prospective, single-center study, consecutive patients with atrial fibrillation underwent first-time BiB-PFA, either PVI only or PVI plus PWI. Venous blood samples were collected before and one day after ablation. Biomarkers included leukocytes, platelets, hemoglobin, C-reactive protein (CRP), haptoglobin, bilirubin, lactate dehydrogenase (LDH), creatinine, estimated glomerular filtration rate (GFR), myoglobin, creatine kinase (CK), and troponin T. Results A total of 60 patients were enrolled (PVI only n = 30, PVI + PWI n = 30). Baseline characteristics were comparable. PVI + PWI required more applications (19 vs. 16; p 0.001) but had similar procedure time. Both groups showed significant increases in inflammatory (CRP, leukocytes), myocardial (troponin T, CK, LDH, myoglobin), and hemolysis markers (bilirubin, LDH, haptoglobin changes; all p 0.001). However, the magnitude of biomarker release did not differ between PVI only and PVI + PWI: Δ troponin T (1,154 vs. 1,029 ng/L, p = 0.694), Δ CK (217 vs. 197 U/L, p = 0.652), Δ CRP (2.7 vs. 3.4 mg/L, p = 0.475), Δ bilirubin (2.4 vs. 2.8 µmol/L, p = 0.842), Δ creatinine (3.3 vs. 9.0 µmol/L, p = 0.085). Conclusion BiB-PFA PVI provokes systemic responses involving inflammation, myocardial injury, and hemolysis. Adjunctive PWI increases application number but does not further increase biomarker release, supporting the biological safety of PWI.
Hatahet et al. (Tue,) conducted a observational in Adults with atrial fibrillation undergoing first-time balloon-in-basket pulsed field ablation (BiB-PFA) (n=60). Balloon-in-basket pulsed field ablation (BiB-PFA) with pulmonary vein isolation plus posterior wall isolation (PVI + PWI) vs. BiB-PFA with pulmonary vein isolation only (PVI only) was evaluated on Change in systemic biomarkers of inflammation, myocardial injury, and hemolysis at 16–18 hours post-ablation (p=No significant difference between groups for all biomarker changes, e.g., Δ troponin T 1154 ng/L vs. 1029 ng/L, p=0.694; Δ CK 217 U/L vs. 197 U/L, p=0.652; Δ CRP 2.7 mg/L vs. 3.4 mg/L, p=0.475; Δ bilirubin 2.4 µmol/L vs. 2.8 µmol/L, p=0.842; Δ creatinine 3.3 µmol/L vs. 9.0 µmol/L, p=0.085). Balloon-in-basket pulsed field ablation with adjunctive posterior wall isolation did not significantly increase systemic biomarker release of inflammation, myocardial injury, or hemolysis compared to pulmonary vein isolation alone in adults undergoing first-time AF ablation.