Periprocedural dynamics of biomarkers of myocardial injury, systemic inflammation and thrombogenicity after pulmonary vein isolation for atrial fibrillation using cryogenic and pulsed field energy

Introduction: Pulmonary vein isolation (PVI) for atrial fibrillation (AF) induces myocardial necrosis. The extent of myocardial injury and systemic inflammatory or thrombotic response may vary depending on the ablation energy modality. It is not known whether the maximum diameter of ‘single shot” ablation catheters influences the magnitude of biomarker release. We aimed to study the temporal profiles of cardiac (high-sensitivity cardiac troponin I, hs-cTn), inflammatory (C-reactive protein, CRP), and thrombotic (D-dimer) biomarkers, as well as creatinine, within 24 hours of PVI, using cryogenic (CBA) or pulsed field energy (PFA). Materials and methods: We prospectively studied consecutive patients with non-permanent AF undergoing first-time PVI by CBA or PFA. Data were collected on the demographic and clinical characteristics, echocardiographic and procedural parameters, and biomarker levels. Blood samples were collected pre-procedure, 6-8 hours post-procedure, and 20-22 hours post-procedure. Repeated measures ANOVA was used for longitudinal comparisons after log-transformation where required; between-group differences were assessed using the Brunner-Munzel test or the chi-square test. A P-value < 0.05 was considered statistically significant. Results: Each group comprised 35 patients with no significant differences in demographic, clinical, or echocardiographic characteristics. Procedure duration was longer with CBA (90 vs 70 min., p < 0.001). hs-cTn increased in both groups, with a higher peak (10217 ng/L vs 5831 ng/L, p = 0.034) and more rapid decline (6431 ng/L vs 4947 ng/L, p = 0.078) in the PFA group. CRP was higher after CBA (11.7 mg/L vs 4.5 mg/L, p < 0.001). D-dimer and creatinine did not change significantly. Biomarker changes were dependent on the time of sample collection and energy modality used, but not on the diameter of the ablation catheter. Conclusion: Compared to CBA, PFA is associated with a substantially greater early increase of hs-cTn within the first few hours, followed by a steeper decline by the following day. CRP increases more after CBA, while D-dimer and creatinine are not affected by either ablation modality.