Inflammation and myocardial injury after pulmonary vein isolation with distinct pulsed field ablation modalities: Comparison with thermal ablation.

BACKGROUND

Pulmonary vein isolation (PVI) was performed using thermal ablation like radiofrequency catheter ablation (RFCA) and cryoballoon ablation (CBA). Pulsed field ablation (PFA) is a novel nonthermal technique that selectively ablates myocardial tissue with minimal collateral damage. However, data comparing post-ablation inflammatory responses among these modalities are limited.

METHODS

Paroxysmal atrial fibrillation (PAF) patients undergoing PVI alone with RFCA, CBA, or PFA were enrolled. The PFA group was subdivided into Farapulse and PulseSelect. Inflammatory markers including white blood cell (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) were measured pre- and post-ablation, with changes (Δ) calculated as post- minus pre-ablation values. High-sensitive troponin I (hs-TnI) was used as myocardial injury marker. Early recurrence of atrial fibrillation (ERAF) was assessed within 3 months.

RESULTS

A total of 313 patients (RFCA: 109, CBA: 110, PFA: 93) were enrolled. ΔWBC was significantly smaller in PFA than CBA (p = 0.005). ΔCRP was smaller in PFA than RFCA and CBA (p = 0.001, p = 0.027, respectively). ΔNLR was smaller in PFA than RFCA (p < 0.001). In PFA, PulseSelect (n = 54) had lower ΔWBC and ΔNLR than Farapulse (n = 39) (p = 0.005 and p = 0.013, respectively). Hs-TnI was higher in PFA compared to RFCA and CBA (p < 0.001 and p < 0.001, respectively). No significant difference in hs-TnI was observed between the PulseSelect and Farapulse. Despite higher hs-TnI in PFA, ERAF rates were similar among the groups.

CONCLUSION

PFA was associated with a significantly lower acute inflammatory response compared to both RFCA and CBA despite the highest hs-TnI value in PFA.