Myocardial Damage, Inflammation, Coagulation, and Platelet Activity During Catheter Ablation Using Radiofrequency and Pulsed-Field Energy

Pulsed-field ablation (PFA) represents a new, non-thermal ablation energy for the ablation of AF. Ablation energies producing thermal injury are associated with an inflammatory response, platelet, and coagulation activation. The study aimed to compare the systemic response in patients undergoing PVI using PF and radiofrequency (RF) energy. Patients with AF indicated for PVI were enrolled and randomly assigned to undergo PVI using RF (CARTO Smart Touch, Biosense Webster) or PF (Farapulse, Boston-Scientific) energy. Markers of myocardial damage (troponin I), inflammation (interleukin-6), coagulation (D-dimers, Fibrin monomers, von Willebrand antigen and factor activity), and platelet activation (P-selectin, activated GpIIb/IIIa antigen) were measured before the procedure (T1), after transseptal puncture, (T2), after completing the ablation in the left atrium (T3), and one day after the procedure (T4). Sixty-five patients were enrolled in the PFA (n=33) and RFA (n=32) groups. Both groups were similar in baseline characteristics (age 60.5±12.7 vs. 64.0±10.7, paroxysmal AF 60.6% vs. 62.5% patients). Procedural and left atrial dwelling times were substantially shorter in the PFA group (55:09±11:57 vs. 151:19±41:25 min, p< 0.001; 36:00±8:05 vs. 115:58±36:49 min, p<0.001). Peak troponin release was substantially higher in the PFA group (10,102ng/L; 8,272–14,207 vs. 1,006ng/L;603–1,433). Both procedures were associated with similar extents (> 50%) of platelet and coagulation activation. The pro-inflammatory response 24 h after the procedure was slightly but non-significantly higher in the RF group. Despite ten times more myocardial damage, PF ablation was associated with a similar degree of platelet/coagulation activation, and slightly lower inflammatory response.