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

Autor:	Osmancik P; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic. Electronic address: pavel.osmancik@gmail.com., Bacova B; Department of Immunology and Clinical Biochemistry, Charles University, Prague, Czech Republic; Department of Laboratory Hematology, Central Laboratories, University Hospital Kralovske Vinohrady, Prague, Czech Republic., Hozman M; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Pistkova J; Department of Immunology and Clinical Biochemistry, Charles University, Prague, Czech Republic; Department of Laboratory Hematology, Central Laboratories, University Hospital Kralovske Vinohrady, Prague, Czech Republic., Kunstatova V; Department of Anesthesiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Sochorova V; Department of Anesthesiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Waldauf P; Department of Anesthesiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Hassouna S; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Karch J; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Vesela J; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Poviser L; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Znojilova L; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Filipcova V; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic., Benesova K; Institute for Biostatistical Analyses, Masaryk University, Brno, Czech Republic., Herman D; Department of Cardiology, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2024 Mar; Vol. 10 (3), pp. 463-474. Date of Electronic Publication: 2023 Nov 06.
DOI:	10.1016/j.jacep.2023.11.001
Abstrakt:	Background: Pulsed-field ablation (PFA) represents a new, nonthermal ablation energy for the ablation of atrial fibrillation (AF). Ablation energies producing thermal injury are associated with an inflammatory response, platelet activation, and coagulation activation. Objectives: This study aimed to compare the systemic response in patients undergoing pulmonary vein isolation (PVI) using pulsed-field and radiofrequency (RF) energy. Methods: Patients with AF indicated for PVI were enrolled and randomly assigned to undergo PVI using RF (CARTO Smart Touch, Biosense Webster) or pulsed-field (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 trans-septal puncture (T2), after completing the ablation in the left atrium (T3), and 1 day after the procedure (T4). Results: A total of 65 patients were enrolled in the pulsed-field ablation (n = 33) and RF ablation (n = 32) groups. Both groups were similar in baseline characteristics (age 60.5 ± 12.7 years vs 64.0 ± 10.7 years; 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 min vs 151:19 ± 41:25 min; P < 0.001; 36:00 ± 8:05 min vs 115:58 ± 36:49 min; P < 0.001). Peak troponin release was substantially higher in the PFA group (10,102 ng/L [IQR: 8,272-14,207 ng/L] vs 1,006 ng/L [IQR: 603-1,433ng/L]). Both procedures were associated with similar extents (>50%) of platelet and coagulation activation. The proinflammatory response 24 h after the procedure was slightly but nonsignificantly higher in the RF group. Conclusions: Despite 10 times more myocardial damage, pulsed-field ablation was associated with a similar degree of platelet/coagulation activation, and slightly lower inflammatory response. (The Effect of Pulsed-Field and Radiofrequency Ablation on Platelet, Coagulation and Inflammation; NCT05603637). Competing Interests: Funding Support and Author Disclosures The study was supported by the National Institute for Research of Metabolic and Cardiovascular Diseases (CarDia), Programme EXCELES, ID project no. LX22NPO5104. This study was funded by the European Union–Next Generation EU, and the Charles University Research Program “Cooperatio-Cardiovascular Science”. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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