Pulsed-field ablation reduces neurocardiac damage versus cryoballoon ablation

Pulsed-field ablation (PFA) was associated with less neurocardiac damage than cryoballoon ablation as a method for pulmonary vein isolation (PVI). The post-interventional increase in heart rate was significantly lower in patients who were randomised to PFA. In contrast, damage to cardiomyocytes was higher in the PFA arm.

PFA is a novel, non-thermal energy source for PVI. Although it is known that thermal energy sources affect the entire atrial tissue during PVI, including nerves and ganglia, the specific impact of PFA on neurocardiac tissue has not yet been investigated [1]. The current study randomised patients undergoing their first PVI (n=56) 1:1 to PFA or cryoballoon ablation. High-sensitive troponin I levels, indicative of myocardial damage, were assessed as well as S100b levels, a measure for neurocardiac damage. The postinterventional increase in heart rate, which is associated with neurocardiac damage, was also analysed. Dr Marc Lemoine (University Heart & Vascular Center Hamburg, Germany) presented the results [2].

S100b levels were 2.9 times lower in the PFA arm than in the cryoballoon ablation arm (P<0.001), suggesting that neurocardiac damage was reduced in the PFA arm. High-sensitive troponin I levels were 3.3 times higher in the PFA arm than in the cryoballoon ablation arm (P<0.01), which indicates that the damage to cardiomyocytes is increased with PFA compared with cryoballoon ablation for PVI. In addition, the ratio of S100b/troponin was reduced for PFA compared with cryoballoon ablation (P<0.01), suggesting that less neurocardiac damage was inflicted per lesion size (see Figure). Furthermore, a post-interventional increase in heart rate was not observed in patients who received PFA, whereas patients who were subjected to cryoballoon ablation showed a significant increase in post-interventional heart rate compared with patients who received PFA (P<0.01).

Figure: S100b/Troponin ratio for PFA and cryoballoon ablation [2]



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“This study validates the experimental concept that PVI by PFA leads to more specific damage to cardiomyocytes than to cardiac ganglia. We observed the loss of post-interventional increase in heart rate in patients who underwent PFA for PVI compared with those who underwent cryoballoon ablation for PVI,” concluded Dr Lemoine.

1. Di Monaco A, et al. J Cardiovasc Dev Dis. 2022;9(4):94.
2. Lemoine M, et al. Pulmonary vein isolation by pulsed-field ablation induces smaller neurocardiac damage than cryoballoon ablation. Atrial fibrillation and ablation, EHRA 2022, 3–5 April, Copenhagen, Denmark.

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Posted on 1 June, 202213 June, 2022