Cardiac biomarker temporal dynamics after radiofrequency and pulsed field catheter ablation of atrial fibrillation

Background There is a lack of data on the temporal dynamics of cardiac biomarkers after radiofrequency and pulsed field ablation (PFA) catheter ablation of atrial fibrillation. Objective To evaluate the kinetics of release of several biomarkers following pulmonary vein isolation (PVI). Methods All patients underwent baseline and regular post-procedural blood sampling (at 3, 24, and 48 hours) to assess major markers of myocardial injury (troponin I, creatinine kinase-MB, and myoglobin) and inflammatory (C-reactive protein [CRP]). The population was stratified into 3 groups according to the ablation system: radiofrequency (RF) ablation catheter (RF group), pentaspline FarapulseTM PFA system (PFA-FAR group), and variable-loop VaripulseTM PFA system (PFA-VAR group). Results A total of 186 patients were included: 79 RF (42.5%), 69 PFA-FAR (37.1%), and 38 PFA-VAR (20.4%). A greater extent of myocardial injury was noticed in the PFA groups vs RF, and cellular electroporation via pentaspline PFA resulted in a greater biomarker increase compared with loop-variable PFA. Kinetics of biomarkers of inflammation increase following PVI with both PFA technologies and RF. However, both PFA systems resulted in a faster CRP biomarker recovery compared with RF, while CRP continued to increase beyond 24 hours post-ablation only in the RF group. PVI was achieved in all patients (100%) using only PFA or RF. Conclusion Cellular electroporation induced by pentaspline PFA was associated with a significantly greater elevation in these cardiac biomarkers compared with variable-loop PFA and RF. After an initial increase, both PFA systems were associated with a more rapid decline in CRP levels compared with RF.