Why the study?
Data were lacking on the temporal dynamics of cardiac biomarkers after radiofrequency and pulsed-field catheter ablation of AF.
Does pulsed-field ablation compared to radiofrequency ablation alter the temporal dynamics of cardiac biomarkers in patients undergoing pulmonary vein isolation for atrial fibrillation?
Does pulsed-field ablation compared to radiofrequency ablation alter the temporal dynamics of cardiac biomarkers in patients undergoing pulmonary vein isolation for atrial fibrillation?
Pulsed-field ablation causes greater initial myocardial injury biomarker release but faster inflammatory marker recovery compared to radiofrequency ablation.
PFA biomarker patterns may warrant monitoring but should not change ablation selection; extends post-PVI injury and inflammation kinetics data.
Background There is a lack of data on temporal dynamics of cardiac biomarkers after radiofrequency and pulsed-field ablation (PFA) catheter ablation of atrial fibrillation (AF). Objective To evaluate the kinetics of release of several biomarkers following pulmonary vein isolation (PVI). Methods All patients underwent baseline and regular post-procedural blood sampling (at 3, 24, and 48-hours) to assess major markers of myocardial injury (troponin I, creatine kinase-MB and myoglobin) and inflammatory (C-reactive protein, C-RP). The population was stratified into three groups according to the ablation system: RF ablation catheter (RF group), pentaspline Farapulse TM PFA system (PFA-FAR group) and variable loop Varipulse TM PFA system (PFA-VAR group). Results A total of 186 patients were included: 79 (42.5%) RF, 69 (37.1%) PFA-FAR and 38 (20.4%), PFA-VAR. A greater extent of myocardial injury was noticed in the PFA groups vs RF, and cellular electroporation via pentaspline PFA resulted in a greater biomarker increase compared to loop-variable PFA. Kinetics of biomarkers of inflammation rise following PVI with both PFA technologies and RF. However, both PFA systems resulted in a faster C-RP biomarker recovery compared to RF while C-RP continued to rise beyond 24 hours post-ablation only in the RF group. PVI was achieved in all patients (100%) using only PFA or RF. Conclusion Cellular electroporation induced by pentaspline PFA was associated with a significantly greater elevation in these cardiac biomarkers compared to variable-loop PFA and RF. After an initial rise, both PFA systems were associated with a more rapid decline in C-RP levels compared to RF.
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Casella et al. (2025) studied this question.
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