1Universitätsklinikum Düsseldorf Klinik für Kardiologie, Pneumologie und Angiologie Düsseldorf, Deutschland
Background
Pulmonary vein isolation (PVI) is the cornerstone in the interventional treatment of atrial fibrillation (AF) and can be performed by various methods. There are thermal and non-thermal methods available to achieve an arrhythmia freedom up to 80% after one year.
PVI through pulsed field ablation (PFA) as the recently established non-thermal ablation method is achieved through cell specific permanent electroporation and therefore should not affect surrounding structures such as the esophagus and neuronal structures. PVI using PFA can be achieved using a single-shot device, as well as using commercially, contact force sensing, solid-tip focal ablation catheters (point-by-point, PbP) connected to a PFA system.
Purpose
We aimed to compare cardiac injury after PVI measured by troponin and CK levels between a PbP PFA (Centauri, Galvanize Therapeutics) and single-shot (Farapulse, Boston Scientific) PFA procedures compared to a standard group treated by radiofrequency ablation (High Power Short Duration, HPSD).
Methods
We studied 140 patients undergoing PVI as first-do procedures using PbP PFA (n=22), single-shot PFA (n=72) and HPSD (n=46). All patients with paroxysmal or persistent AF refractory to antiarrhythmic treatment (class I and III antiarrhythmics) were considered eligible if they were older than 18 years of age, and provided informed consent before inclusion.
We collected blood samples from the coronary sinus ostium (CS) before and immediately after the procedure and measured the levels of high-sensitive troponin and serum creatinine kinase (CK). Comorbidities, medications and epidemiological data were recorded and analyzed.
Results
There were no significant differences between the three groups regarding age, CHA2DS2-VASc score and comorbidities. 55% of the patients presented with paroxysmal AF and 45% with persistent AF.
There were no significant differences in cardiac injury markers at baseline.
The troponin release was highest in the group of patients treated by PbP PFA. The difference was statistically significant for PbP PFA as compared to single-shot PFA (p<0.001) and HPSD (p=0.002), respectively. There was no significant difference between the single-shot PFA and HPSD group (p=0.103).
The CK levels have also shown to be highest in patients treated by PbP PFA, but there was no significant difference as compared to single-shot PFA. However, the CK levels were significantly lower in patients treated by HPSD as compared to the single-shot PFA (p<0.001) and the PbP PFA (p<0.001).
Conclusion
The cardiac injury marker release differs according to the ablation technique used for PVI. The immediate release was highest in patients treated by PbP PFA, theoretically suggesting transmural lesions. However, the impact of these differences on the clinical outcome after PVI should be further studied.