Pulsed-field ablation of atrial fibrillation: kinetics of release of multiple cardiac biomarkers

Different studies have showed data on the variation of cardiac biomarkers after a thermal energy approach (i.e. cryoablation or radiofrequency) for the ablation of atrial fibrillation (AF). To date, when a non-thermal energy is used, such as electroporation obtained by means of a pulsed-field ablation (PFA), the kinetic of release of multiple cardiac biomarkers has not yet been clarified. We studied the pattern of release of 6 different biomarkers prior and after PFA of AF. All consecutive patients (pts) indicated for AF ablation who received a PFA treatment with the new PFA catheter (FARAWAVE) at our center were included. PVI was obtained using 2 kV with 8 applications per vein with additional lesions delivered at the operator’s discretion. Samples of cardiac troponin I (cTnI, ng/l), creatinine kinase-MB (CK-MB, ng/dl), fibrinogen (FB, mg/dl), myoglobin (MY, ng/ml), N-terminal (NT)-pro hormone B-type natriuretic peptide (NT-ProBNP, pg/ml) and C-reactive protein (CRP, mg/dl) were collected before PFA ablation (baseline) and at 3h, 24h and 48h after ablation. Data are reported as mean±SD. We analyzed data from a total of 25 pts (64±11 years, 52% male, 68% with paroxysmal AF). A total of 36±3 PFA deliveries was required to achieve PVI. In ten cases an additional set of PFA lesions was performed (25±6 PFA deliveries). No significant differences were found between baseline and 3h, 24h and 48h for both FB and NT-ProBNP (Panel a,b). On the contrary, MY level significantly increased from baseline at 3h and decreased at 24h and restored at 48h (Panel c). CRP values remained stable at 3h and significantly increased from baseline after 24h and 48h (Panel d). Kinetics of CK-MB and cTnI were similar: they both significantly increased after 3h and decreased after 24h and 48h (Panel e,f). No correlation was found between the total number of PFA deliveries and kinetics of different biomarkers after 3h, 24h and 48h. CK-MB, cTnI, and MY increased at 3h and have a recover towards lower values already after 24h. Cardiac enzyme elevations were not correlated with the number of PFA deliveries after AF ablation.