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. 2024 Feb;35(2):317-327.
doi: 10.1111/jce.16157. Epub 2023 Dec 17.

Myocardial injury and inflammation following pulsed-field ablation and very high-power short-duration ablation for atrial fibrillation

Miruna A Popa  1   2   3   4 , Fabian Bahlke  1   2 , Marc Kottmaier  1   2 , Leonie Foerschner  1   2 , Felix Bourier  1   2 , Sarah Lengauer  1   2 , Marta Telishevska  1   2 , Hannah Krafft  1   2 , Florian Englert  1   2 , Tilko Reents  1   2 , Carsten Lennerz  1   2 , Guido Caluori  4 , Pierre Jaïs  3   4 , Gabriele Hessling  1   2 , Isabel Deisenhofer  1   2
Affiliations

Myocardial injury and inflammation following pulsed-field ablation and very high-power short-duration ablation for atrial fibrillation

Miruna A Popa et al. J Cardiovasc Electrophysiol. 2024 Feb.

Abstract

Introduction: Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is an established treatment strategy for atrial fibrillation (AF). To improve PVI efficacy and safety, high-power short-duration (HPSD) ablation and pulsed-field ablation (PFA) were recently introduced into clinical practice. This study aimed to determine the extent of myocardial injury and systemic inflammation following PFA, HPSD, and standard RFA using established biomarkers.

Methods: We included 179 patients with paroxysmal AF receiving first-time PVI with different ablation technologies: standard RFA (30-40 W/20-30 s, n = 52), power-controlled HPSD (70 W/5-7 s, n = 60), temperature-controlled HPSD (90 W/4 s, n = 32), and PFA (biphasic, bipolar waveform, n = 35). High-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), CK MB isoform (CK-MB), and white blood cell (WBC) count were determined before and after ablation.

Results: Baseline characteristics were well-balanced between groups (age 63.1 ± 10.3 years, 61.5% male). Postablation hs-cTnT release was significantly higher with PFA (1469.3 ± 495.0 ng/L), HPSD-70W (1322.3 ± 510.6 ng/L), and HPSD-90W (1441.2 ± 409.9 ng/L) than with standard RFA (1045.9 ± 369.7 ng/L; p < .001). CK and CK-MB release was increased with PFA by 3.4-fold and 5.8-fold, respectively, as compared to standard RFA (p < .001). PFA was associated with the lowest elevation in WBC (Δ1.5 ± 1.5 × 109 /L), as compared to standard RFA (Δ3.8 ± 2.5 × 109 /L, p < .001), HPSD-70W (Δ2.7 ± 1.7 × 109 /L, p = .037), and HPSD-90W (Δ3.6 ± 2.5 × 109 /L, p < .001).

Conclusion: Among the four investigated ablation technologies, PFA was associated with the highest myocardial injury and the lowest inflammatory reaction.

Keywords: atrial fibrillation; high-power short-duration; inflammation; myocardial injury; pulsed-field ablation; radiofrequency ablation.

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References

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