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Comparative Study
. 2025 Aug 2;30(1):700.
doi: 10.1186/s40001-025-02964-y.

A comparative analysis of postprocedural troponin levels and the impact of renal impairment in patients undergoing pulmonary vein isolation: pulsed field ablation vs. radiofrequency ablation

Sebastian Feickert  1   2 , Giuseppe D'Ancona  3 , Kristof Biernath  3   4 , Elisabeth Pieske-Kraigher  3 , Jasmin Ortak  4 , Niels Christian Ewertsen  3   4
Affiliations
Comparative Study

A comparative analysis of postprocedural troponin levels and the impact of renal impairment in patients undergoing pulmonary vein isolation: pulsed field ablation vs. radiofrequency ablation

Sebastian Feickert et al. Eur J Med Res. .

Abstract

Background: Pulsed field ablation (PFA) has emerged as a novel nonthermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While it offers distinct advantages over traditional radiofrequency ablation (RFA), including a favorable safety profile, its impact on myocardial injury, as reflected by biomarker plasma concentrations, remains underexplored.

Objectives: This study aimed to compare postprocedural high-sensitivity troponin-T (hs-TnT) and creatine kinase (CK) levels in patients undergoing PVI with PFA versus RFA and to identify independent predictors of myocardial injury.

Methods: We analyzed 94 patients (48 PFA, 46 RFA) undergoing PVI for paroxysmal or persistent AF. Biomarkers (hs-TnT and CK) were measured preprocedure and 24 h postprocedure. Baseline clinical and procedural characteristics were evaluated for comparability. Statistical analyses included linear regression with permutation feature importance to identify predictors of postprocedural troponin levels.

Results: Patients undergoing PFA exhibited significantly higher median hs-TnT levels at 24 h postprocedure compared to those treated with RFA (1071.0 ng/L [IQR: 861.0-1316.5] vs. 602.5 ng/L [IQR: 504.0-795.5]; p < 0.001). Similarly, CK levels were markedly higher in the PFA group (286.0 U/L [IQR: 215.0-356.5] vs. 122.5 U/L [IQR: 90.5-190.5]; p < 0.001). Baseline levels of both biomarkers were comparable between groups. Linear regression identified PFA as the most significant determinant of troponin plasma concentration, followed by preprocedural GFR, with reduced GFR correlating with greater troponin elevation.

Conclusions: PFA is associated with higher myocardial biomarker plasma concentration compared to RFA, suggesting greater myocardial injury. Reduced GFR amplifies this effect, underscoring the importance of careful patient selection and procedural planning, particularly in patients with renal impairment. While PFA shows promise as a safe and effective ablation strategy, further research is needed to assess its long-term clinical implications.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The implementation of this study was approved by a positive ethics vote from the Ethics Committee of the University of Rostock (Reg.-Nr. A2023-0213). All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all individual participants included in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study workflow and data acquisition. CK   Creatin kinase, PVI   Pulmonary vein isolation
Fig. 2
Fig. 2
Comparison of troponin and creatine kinase values pre- and postprocedural after PFA or CBA. PFA   Pulsed field ablation, CBA   Cryoballoon ablation, CK   Creatin kinase
Fig. 3
Fig. 3
Independent variables contribution to the linear regression model (dependent variable = postprocedural troponin–preprocedural troponin)
See this image and copyright information in PMC

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