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.