A comparative analysis of postprocedural troponin levels and the impact of renal impairment in patients undergoing pulmonary vein isolation: pulsed field ablation vs. radiofrequency ablation.

Background: Pulsed field ablation (PFA) has emerged as a novel nonthermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While it offers distinct advantages over traditional radiofrequency ablation (RFA), including a favorable safety profile, its impact on myocardial injury, as reflected by biomarker plasma concentrations, remains underexplored.

Objectives: This study aimed to compare postprocedural high-sensitivity troponin-T (hs-TnT) and creatine kinase (CK) levels in patients undergoing PVI with PFA versus RFA and to identify independent predictors of myocardial injury.

Methods: We analyzed 94 patients (48 PFA, 46 RFA) undergoing PVI for paroxysmal or persistent AF. Biomarkers (hs-TnT and CK) were measured preprocedure and 24 h postprocedure. Baseline clinical and procedural characteristics were evaluated for comparability. Statistical analyses included linear regression with permutation feature importance to identify predictors of postprocedural troponin levels.

Results: Patients undergoing PFA exhibited significantly higher median hs-TnT levels at 24 h postprocedure compared to those treated with RFA (1071.0 ng/L [IQR: 861.0-1316.5] vs. 602.5 ng/L [IQR: 504.0-795.5]; p < 0.001). Similarly, CK levels were markedly higher in the PFA group (286.0 U/L [IQR: 215.0-356.5] vs. 122.5 U/L [IQR: 90.5-190.5]; p < 0.001). Baseline levels of both biomarkers were comparable between groups. Linear regression identified PFA as the most significant determinant of troponin plasma concentration, followed by preprocedural GFR, with reduced GFR correlating with greater troponin elevation.

Conclusions: PFA is associated with higher myocardial biomarker plasma concentration compared to RFA, suggesting greater myocardial injury. Reduced GFR amplifies this effect, underscoring the importance of careful patient selection and procedural planning, particularly in patients with renal impairment. While PFA shows promise as a safe and effective ablation strategy, further research is needed to assess its long-term clinical implications.