Pulsed-field ablation resulted in substantially higher myocardial damage (troponin 10,102 vs 1,006) compared to radiofrequency ablation, but similar platelet, coagulation, and inflammatory activation.
RCT (n=65)
Randomly assigned
Does pulsed-field ablation compared to radiofrequency ablation alter markers of cellular damage, inflammation, coagulation, and platelet activity in patients undergoing pulmonary vein isolation for atrial fibrillation?
Pulsed-field ablation for atrial fibrillation results in significantly shorter procedure times and higher myocardial damage (troponin release) than radiofrequency ablation, without increasing inflammatory or prothrombotic responses.
Absolute Event Rate: 10102% vs 1006%
Introduction: Pulsed-field ablation (PFA) presents a new technology for the ablation of AF using non-thermal ablation energy. Ablation energies producing thermal injury are associated with an inflammatory response, platelet activation, and coagulation cascade activation. The study aimed to compare markers of cell damage and platelet and coagulation activation in patients undergoing PVI using PF and radiofrequency (RF) energy. Hypothesis: PFA will be associated will more pronounced myocardial damage, but less pronounced activation of platelets and inflammation. Methods: Patients with AF indicated for PVI were enrolled and randomly assigned to undergo PVI using RF (CARTO Smart Touch, Biosense Webster, USA) or PF (Farapulse, Boston-Scientific, USA) energy. Markers of myocardial damage (high-sensitivity troponin I), apoptosis (Fas ligand, caspase-3), inflammation (interleukin-6), coagulation (D-dimers, Fibrin monomers, von Willebrand antigen and factor activity), platelet activation (P-selectin, activated Gp IIb/IIIa antigen and CD42b), and neuron axon damage (NGF-β) were measured before the procedure (T1), after transseptal puncture, (T2), after completing the ablation in the left atrium (T3), and one day after the procedure (T4). Results: Sixty-five patients were enrolled in the PFA (n=33) and RFA (n=32) groups. Both groups were similar in baseline characteristics (age 60.5±12.7 vs. 64.0±10.7 and 20 (60.6%) non-paroxysmal vs. 20 (62.5%) paroxysmal AF). Procedural and left atrial dwelling times were substantially shorter in the PFA group (55:09±11:57 vs. 151:19±41:25 min, p< 0.001; 36:00±8:05 vs. 115:58±36:49 min, p<0.001). Troponin release (1 d after the procedure) was substantially higher in the PFA group (10,102, IQR 8,272-14,207 vs. 1,006, IQR 603-1,433) and was ten times higher in PFA patients. However, during the procedure, markers of platelet activation, coagulation activation, and inflammation were similar between groups. Conclusions: PF ablation was associated with substantially more myocardial damage compared to radiofrequency ablation. However, coagulation activation, platelet activation, and inflammatory responses were similar.
Osmančík et al. (Tue,) conducted a rct in Atrial Fibrillation (n=65). Pulsed-field ablation vs. Radiofrequency ablation was evaluated on Troponin release 1 day after the procedure. Pulsed-field ablation resulted in substantially higher myocardial damage (troponin 10,102 vs 1,006) compared to radiofrequency ablation, but similar platelet, coagulation, and inflammatory activation.