Pulsed field ablation may cause less neurocardiac damage vs. cryoballoon ablation for AF
Key takeaways:
- Pulmonary vein isolation with pulsed field ablation may cause less neurocardiac damage vs. cryoballoon ablation.
- Reduced damage was evidenced by no increase in heart rate after pulsed field ablation.
Pulsed field ablation pulmonary vein isolation for atrial fibrillation may confer less damage to cardiac nerves and ganglia vs. cryoballoon ablation, researchers reported.
Reduced damage was reflected by reduced expression of the neuronal biomolecule, S100B, and lack of heart rate increase following pulsed field ablation compared with cryoballoon ablation for pulmonary vein isolation (PVI), according to data published in Circulation: Arrhythmia and Electrophysiology.
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“[PVI can] damage adjacent anatomical structures like cardiac nerves and ganglionated plexi embedded in the epicardial fat pads at the left atrial posterior wall. These contribute to cardiac autonomic regulation,” Marc D. Lemoine, MD, clinician scientist in cardiology at the University Heart and Vascular Center in Hamburg, Germany, and colleagues wrote.
In contrast, pulsed field ablation disrupts cardiomyocyte membranes by electroporation. Lemoine and colleagues posited that PVI with this technique could preserve extracardiac anatomical structures; however, nonmyelinated autonomic nerves may occasionally by injured, whereas myelinated nerves were unaffected.
“To determine whether this selectivity for cardiomyocytes with sparing of neuronal tissue is found in patients, we compared the release of cardiac (Troponin) and neuronal (S100B) biomolecules into the circulation after PVI using pulsed field ablation and cryoballoon ablation in patients,” the researchers wrote.
Pulsed field ablation vs. cryoballoon ablation
For this study, blood samples were obtained from 91 consecutive patients before and after first PVI using the pulsed field ablation pentaspline catheter (Farawave, Farapulse/Boston Scientific) or cryoballoon ablation (Arctic Front Advance Pro, Medtronic).
A total of 51 patients underwent pulsed field ablation (mean age, 68 years; 36 men) and 40 underwent cryoballoon ablation (mean age, 63 years; 26 men).
After successful PVI, researchers observed increased high-sensitivity troponin I and S100B plasma concentration in patients who underwent pulsed field ablation (mean S100B, from 34 pg/mL to 62 pg/mL; mean high-sensitivity troponin I, from 11 pg/mL to 429 pg/mL; P < .001) and cryoballoon ablation (mean S100B, from 38 pg/mL to 106 pg/mL; mean high-sensitivity troponin I, from 5 pg/mL to 168 pg/mL; P < .001).
Release of S100B was up to threefold lower after pulsed field ablation compared with cryoballoon ablation (P < .001), whereas high-sensitivity troponin I increased threefold after pulsed field ablation compared with cryoballoon ablation (P = .01), according to the study.
Lemoine and colleagues reported that the S100B-to-high-sensitivity troponin I ratio — as a surrogate of neurocardiac/cardiomyocyte damage — was approximately fourfold lower after pulsed field ablation compared with cryoballoon ablation (P < .001).
Change in heart rate after PVI
In a cohort of patients with paroxysmal AF, heart rates after pulsed field ablation PVI were unchanged (from 64 bpm to 64 bpm; P = .989) whereas heart rates were elevated after cryoballoon ablation PVI (from 61 bpm to 71 bpm; P < .001), according to the study.
Moreover, the difference in change in heart rate after PVI with pulsed field ablation compared with cryoballoon ablation was confirmed using ECG monitors at the postinterventional day (mean change, 5.8 bpm vs. 1.1 bpm; P = .002).
“These data show that pulsed field ablation PVI induces less neuronal damage quantified by a neuron-specific biomarker compared with cryoballoon ablation PVI,” the researchers wrote. “This leads to a preserved vagal control of heart rate after pulsed field ablation PVI. The findings replicate theoretical predictions and preclinical data suggesting a relative cardiomyocyte-specificity of pulsed field ablation-based ablation in patients undergoing routine PVI.”
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