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. (Thu,) studied this question.