Comparative analysis of myocardial injury biomarkers following pulsed field ablation versus radiofrequency ablation in atrial fibrillation patients

Abstract Background Pulsed field ablation (PFA) has emerged as a novel technology for atrial fibrillation (AF) treatment, yet comparative myocardial injury profiles versus radiofrequency (RF) ablation remain incompletely characterized. Purpose We sought to compare acute myocardial injury by assessing variations in high –sensitivity cardiac troponin I (cTnI, ng/L), creatine kinase-MB (CK-MB, mg/dL) and lactate dehydrogenase (LDH, IU/L) following pulmonary vein isolation (PVI) performed with different PFA technologies: Farapulse PFA (PFA-FAR), Affera PFA (PFA-AFFE), and RF ablation. Methods We analyzed 91 consecutive patients undergoing AF ablation (PFA n=34, RF n=57) with complete biomarker data. All patients received uninterrupted Direct Oral Anticoagulant (DOAC) preoperatively and they were divided in distinct groups depending on whether they underwent PFA or RF ablation. In the PFA group ablation was performed via Affera™ and FARAPULSE™ PFA systems. In the RF group ablation was performed via THERMOCOOL SMARTTOUCH® SF Catheter. High –sensitivity cTn, CK-MB and LDH were measured pre- and post-ablation in all patients. Results All three biomarkers demonstrated significantly greater elevation with PFA versus RF ablation (Figure 1). Troponin showed the largest difference (median change: 7,654 vs 992 ng/L; 7.7-fold higher; p0.001; Cohen's d=1.63). CK exhibited the greatest effect size (median change: 285 vs 27 U/L; 10.6-fold higher; p0.001; Cohen's d=2.01). LDH showed significant but smaller elevation (median change: 108 vs 36 U/L; 3.0-fold higher; p=0.042; Cohen's d=0.61). Biomarker changes were significantly correlated (troponin-CK: r=0.37, p0.01), suggesting common underlying myocardial injury mechanisms. The type of periprocedural anticoagulation did not influence myocardial injury markers (Kruskal-Wallis p=0.42 for troponin), and no significant method-anticoagulant interaction was observed. Conclusions In our study cellular electroporation via PFA induced substantially greater myocardial injury than RF ablation across multiple biomarkers. As PFA gains widespread acceptance, further research is essential to investigate clinical implications of increased myocardial damage despite PFA's tissue selectivity advantages.For image description, please refer to the figure legend and surrounding text.