Key result
PFA linked to ~100-fold higher post-procedural troponin release than RFA in atrial fibrillation.
Its licence doesn't allow us to show a copy here.
Why the study?
Non-target tissue collateral damage created by electroporation effects is poorly understood and may significantly differ between pulsed field ablation systems.
Does pulsed field ablation compared to radiofrequency ablation increase collateral tissue damage and biomarker release in patients undergoing atrial fibrillation ablation?
Observational (n=871)
Yes
Does pulsed field ablation compared to radiofrequency ablation increase collateral tissue damage and biomarker release in patients undergoing atrial fibrillation ablation?
Absolute Event Rate: 13551% vs 127.5%
p-value: p=<0.001
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We, I believe, traded off one set of major problems, which is PV stenosis, esophageal injury, and phrenic nerve damage, for a set of maybe not as dire complications. But they're still significant enough that we should be paying attention to them.”
“Certainly, a lot of industry is pushing PFA as the next best thing, but I think over the years we have learned that... it's not quite as perfect as they are selling it.”
“I think the net benefits to the patient are significant.”
Pulsed field ablation is associated with significantly higher markers of myocardial injury and hemolysis compared to radiofrequency ablation, suggesting greater collateral tissue effects.
BACKGROUND Early evidence showed reduced complications with pulsed field ablation (PFA), but non-target tissue collateral damage created by electroporation effects is poorly understood and may significantly differ between systems. OBJECTIVE In this study, we evaluate the collateral effects of PFA. METHODS NEMESIS-PFA is a multicenter, observational registry of patients who underwent AF ablation from March 2024 onwards with any approved PFA systems - either a circular multielectrode array, spherical, pentaspline, or variable loop catheter - or radiofrequency ablation (RFA). We assessed procedural characteristics, biomarkers for myocardial injury, hemolytic anemia, and renal function, and left atrial (LA) function in select patients. RESULTS A total of 871 patients, aged 68.9±10.9 years and male (70.8%), with paroxysmal (59.4%) atrial fibrillation, and CHA2DS2VASC of 3.3±1.3 were included. Of these, 87.1% (n=773) underwent PFA with a pentaspline (70.9%), circular multielectrode (14.1%), spherical (12.4%), and variable loop (2.3%) catheter. Significant post-procedural change in certain biomarkers such as troponin (13551.0 vs., 127.5 p<0.001), LDH (107.5 IU/L vs. 26.5, p<0.001), and haptoglobin (-102.0 mg/dL vs. -33.5, p<0.001) were detected following the PFA procedures compared to RFA, and the change was dose dependent. There were also significant differences in biomarkers across PFA systems. Lastly, there was a significant change in LA ejection fraction (-5.0% vs. -20.0%, p<0.001) in PFA versus RFA. CONCLUSIONS Current PFA technologies are associated with higher troponin leak, hemolysis, renal dysfunction than RFA. As PFA becomes mainstream, future studies appraising these effects and understanding the short term and long-term implications are needed. NEMESIS-PFA is a multicenter observational study of patients undergoing pulsed-field (PFA) or radiofrequency (RFA) ablation for atrial fibrillation. 871 patients underwent PFA (87.7%) with pentaspline (70.9%), circular multielectrode (14.1%), spherical (12.4%), or variable loop (2.3%) catheters, or RFA (11.2%). Changes in troponin (127.5 vs. 13551.0 ng/dL, p<0.001), lactate dehydrogenase (26.5 vs. 107.5 IU/L, p=0.007), and haptoglobin (-33.5 vs. -102.0 mg/dL, p<0.001) were significantly higher in PFA than RFA; they were also dose-dependent and varied across systems. Left atrial ejection fraction (-5.0% vs. -20.0%, p<0.001) also differed. This suggests that collateral effects of PFA are worse than RFA and requires additional study.
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Katapadi et al. (2025) conducted an observational in Atrial fibrillation (n=871). Pulsed field ablation (PFA) vs. Radiofrequency ablation (RFA) was evaluated on Post-procedural change in troponin (ng/dL) (p=<0.001). Pulsed field ablation for atrial fibrillation was associated with significantly higher troponin leak (13551.0 vs 127.5 ng/dL, p<0.001) compared to radiofrequency ablation.
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