Pulsed-field ablation caused nearly 10 times more myocardial damage than radiofrequency ablation (median peak troponin I 10,102 ng/L vs 1,006 ng/L, p<0.001), but resulted in similar platelet and coagulation activation.
RCT (n=65)
Web-based electronic system stratified by AF type, left atrial size, and age
No
Does pulsed-field ablation compared to radiofrequency ablation alter the systemic response of myocardial damage, inflammation, coagulation, and platelet activity in patients undergoing pulmonary vein isolation for atrial fibrillation?
Pulsed-field ablation for atrial fibrillation causes significantly greater myocardial damage (troponin release) than radiofrequency ablation, but elicits a similar degree of platelet and coagulation activation and a comparable inflammatory response.
Absolute Event Rate: 10102% vs 1006%
p-value: p=<0.001
BACKGROUND: Pulsed-field ablation (PFA) represents a new, nonthermal ablation energy for the ablation of atrial fibrillation (AF). Ablation energies producing thermal injury are associated with an inflammatory response, platelet activation, and coagulation activation. OBJECTIVES: This study aimed to compare the systemic response in patients undergoing pulmonary vein isolation (PVI) using pulsed-field and radiofrequency (RF) energy. METHODS: Patients with AF indicated for PVI were enrolled and randomly assigned to undergo PVI using RF (CARTO Smart Touch, Biosense Webster) or pulsed-field (Farapulse, Boston-Scientific) energy. Markers of myocardial damage (troponin I), inflammation (interleukin-6), coagulation (D-dimers, fibrin monomers, von Willebrand antigen and factor activity), and platelet activation (P-selectin, activated GpIIb/IIIa antigen) were measured before the procedure (T1), after trans-septal puncture (T2), after completing the ablation in the left atrium (T3), and 1 day after the procedure (T4). RESULTS: A total of 65 patients were enrolled in the pulsed-field ablation (n = 33) and RF ablation (n = 32) groups. Both groups were similar in baseline characteristics (age 60.5 ± 12.7 years vs 64.0 ± 10.7 years; paroxysmal AF: 60.6% vs 62.5% patients). Procedural and left atrial dwelling times were substantially shorter in the PFA group (55:09 ± 11:57 min vs 151:19 ± 41:25 min; P 50%) of platelet and coagulation activation. The proinflammatory response 24 h after the procedure was slightly but nonsignificantly higher in the RF group. CONCLUSIONS: Despite 10 times more myocardial damage, pulsed-field ablation was associated with a similar degree of platelet/coagulation activation, and slightly lower inflammatory response. (The Effect of Pulsed-Field and Radiofrequency Ablation on Platelet, Coagulation and Inflammation; NCT05603637).
Osmančík et al. (Mon,) conducted a rct in Atrial fibrillation (n=65). Pulsed-field ablation vs. Radiofrequency ablation was evaluated on Peak high-sensitivity troponin I concentration at 24 hours (p=<0.001). Pulsed-field ablation caused nearly 10 times more myocardial damage than radiofrequency ablation (median peak troponin I 10,102 ng/L vs 1,006 ng/L, p<0.001), but resulted in similar platelet and coagulation activation.
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