Pulmonary vein isolation (PVI) using radiofrequency catheter ablation (RFA) is an established treatment strategy for atrial fibrillation. In an effort to improve PVI efficacy and safety, high-power short-duration (HPSD) RF ablation and pulsed-field ablation (PFA) were recently introduced as alternative ablation strategies. However, the effect of PFA and HPSD ablation on myocardial injury and systemic inflammation remains incompletely characterized in the clinical setting.
Aim:
This study aimed to determine the extent of myocardial injury and of systemic inflammation following PFA and RFA using established plasma biomarkers.
Methods:
We retrospectively analyzed 179 patients with paroxysmal AF who received first-time PVI at our center. Patients were divided into 4 groups, according to the ablation modality and power/duration settings employed: conventional RFA (group 1: 30-40 W/20-30 sec, n = 52), power-controlled HPSD ablation (group 2: 70 W/7 sec, n = 60), temperature-controlled HPSD (group 3: 90 W/4 sec, n = 32) and PFA (group 4: biphasic and bipolar waveform using the FARAWAVE catheter, n = 35). High-sensitive troponin T (hsTropT), creatine kinase (CK), CK-MB and white blood cell (WBC) count were determined at baseline, one day and two days after ablation in fresh plasma samples. Statistical analysis was performed using one-way ANOVA with Tukey’s multiple comparisons test.
Results:
Baseline characteristics were well-balanced between groups (age 63.1 ± 10.3 years, 61.5% male, p > 0.05). Successful PVI was achieved in all patients. Mean power (32.7 ± 3.1 W vs. 54.4 ± 7.6 W vs. 74.1 ± 12 W) and mean RF duration (45.6 ± 17.3 min vs. 14.5 ± 6.3 min vs. 11.5 ± 3.5 min) were significantly different between groups 1, 2 and 3, respectively (all p < 0.001). Post-ablation hsTropT levels were significantly higher in the HPSD-70W (1330.6 ± 137.9 ng/l), HPSD-90W (1449.6 ± 411.9 ng/l) and PFA (1479.3 ± 497.2 ng/l) group as compared to the conventional ablation group (1054.0 ± 370.3 ng/l; all p < 0.001). Post-ablation hsTropT increase was similar between PFA, HPSD-70W and HPSD-90W groups (p > 0.05). Post-ablation CK and CK-MB levels were significantly higher in the PFA group (319.7 ± 117.2 U/l and 35.1 ± 9.7 U/l) as compared to all three RFA groups (107.7 ± 53.2 U/l and 17.3 ± 6.7 U/l in group 1, 115.7 ± 68.9 U/l and 16.7 ± 8.1 U/l in group 2, 115.9 ± 59.5 U/l and 16.6 ± 4.5 U/l in group 3). PFA was associated with the lowest increase in post-ablation WBC count (1.5 ± 1.5 x 109/l), as compared to group 1 (3.8 ± 2.5 x 109/l, p<0.001), group 2 (2.7 ± 1.7 x 109/l, p=0.037) and group 3 (3.6 ± 2.5 x 109/l, p<0.001).
Conclusion:
Among the four ablation strategies tested, PFA was associated with the highest myocardial injury and the lowest inflammatory reaction. Whether these findings translate into improved rhythm outcomes and less early arrhythmia recurrences remains to be established.
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