Atrial fibrillation ablation: Limitations of pulmonary vein ablation catheter technology

Wójcik, Maciej; Berkowitsch, Alexander; Kuniss, Malte; Neumann, Thomas

doi:10.5603/cj.2014.0077

Cited by 2 publications

(2 citation statements)

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“…Concerning the predictive value of myocardial injury and inflammation biomarkers for rhythm outcomes, we found that hs-cTnT release is associated with a decreased risk of arrhythmia recurrence in the standard RFA group. This is in agreement with previous studies on RFA 29,30 and suggests that a more extensive ablation is beneficial for rhythm outcomes, probably due to more durable lesions preventing PV reconnections. While hs-cTnT release is significantly higher with PFA and vHPSD, it is not predictive of rhythm outcome within these groups.…”

Section: Discussionsupporting

confidence: 93%

Myocardial injury and inflammation following pulsed‐field ablation and very high‐power short‐duration ablation for atrial fibrillation

Popa,

Bahlke,

Kottmaier

et al. 2023

Cardiovasc electrophysiol

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IntroductionPulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is an established treatment strategy for atrial fibrillation (AF). To improve PVI efficacy and safety, high‐power short‐duration (HPSD) ablation and pulsed‐field ablation (PFA) were recently introduced into clinical practice. This study aimed to determine the extent of myocardial injury and systemic inflammation following PFA, HPSD, and standard RFA using established biomarkers.MethodsWe included 179 patients with paroxysmal AF receiving first‐time PVI with different ablation technologies: standard RFA (30–40 W/20–30 s, n = 52), power‐controlled HPSD (70 W/5–7 s, n = 60), temperature‐controlled HPSD (90 W/4 s, n = 32), and PFA (biphasic, bipolar waveform, n = 35). High‐sensitivity cardiac troponin T (hs‐cTnT), creatine kinase (CK), CK MB isoform (CK‐MB), and white blood cell (WBC) count were determined before and after ablation.ResultsBaseline characteristics were well‐balanced between groups (age 63.1 ± 10.3 years, 61.5% male). Postablation hs‐cTnT release was significantly higher with PFA (1469.3 ± 495.0 ng/L), HPSD‐70W (1322.3 ± 510.6 ng/L), and HPSD‐90W (1441.2 ± 409.9 ng/L) than with standard RFA (1045.9 ± 369.7 ng/L; p < .001). CK and CK‐MB release was increased with PFA by 3.4‐fold and 5.8‐fold, respectively, as compared to standard RFA (p < .001). PFA was associated with the lowest elevation in WBC (Δ1.5 ± 1.5 × 109/L), as compared to standard RFA (Δ3.8 ± 2.5 × 109/L, p < .001), HPSD‐70W (Δ2.7 ± 1.7 × 109/L, p = .037), and HPSD‐90W (Δ3.6 ± 2.5 × 109/L, p < .001).ConclusionAmong the four investigated ablation technologies, PFA was associated with the highest myocardial injury and the lowest inflammatory reaction.

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Section: Discussionsupporting

confidence: 93%

Myocardial injury and inflammation following pulsed‐field ablation and very high‐power short‐duration ablation for atrial fibrillation

Popa,

Bahlke,

Kottmaier

et al. 2023

Cardiovasc electrophysiol

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“…We would like to thank Wójcik et al [1] for their valuable comments to our paper [2] which inspired us to further discussion. In our cohort, we observed an important discrepancy between electrophysiological and clinical efficacy.…”

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confidence: 99%

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Balsam

Koźluk

2014

Cardiol J

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Atrial fibrillation ablation: Limitations of pulmonary vein ablation catheter technology

Cited by 2 publications

References 5 publications

Myocardial injury and inflammation following pulsed‐field ablation and very high‐power short‐duration ablation for atrial fibrillation

Myocardial injury and inflammation following pulsed‐field ablation and very high‐power short‐duration ablation for atrial fibrillation

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