Pulsed field ablation systems differentially affect cardiac biomarkers in atrial fibrillation
Y Yamazaki, K Tokutake, U Takato, R Sakurai, S Shiomi, T Matsumoto, H Sato, H Oseto, M Yokoyama, S Yamashita, M Tokuda, T YamaneAbstract
Background
Pulsed field ablation (PFA) has recently emerged as a novel energy source for the treatment of atrial fibrillation (AF). Although its safety and efficacy have been well established, the extent of myocardial injury may differ depending on the device used.
Purpose
To investigate whether different PFA systems have effects on cardiac biomarkers in atrial fibrillation patients.
Methods
A total of 81 patients who underwent PFA between April 2024 and October 2025 at our hospital were enrolled. Of these, 39 were treated with PulseSelect, 25 with FARAPULSE, and 17 with VARIPULSE. All patients underwent pulmonary vein isolation (PVI) using PFA only; those with additional ablation lesions or radiofrequency applications were excluded. Laboratory markers of myocardial injury—including AST, LDH, CK, WBC, and troponin I (TnI)—were measured at baseline and 1 day after the procedure. Changes in biomarker levels (Δcardiac biomarkers) were compared among the three groups.
Results
The mean number of applications was 37.6 with PulseSelect, 37.3 with FARAPULSE, and 17.8 with VARIPULSE. Significant differences were observed in ΔAST, ΔLDH, ΔCK, and ΔTnI among the three device groups (p < 0.05). In multiple comparisons of these four biomarkers, the Δvalues were significantly lower in the VARIPULSE group than in the PulseSelect and FARAPULSE groups. The FARAPULSE group tended to show the greatest increase in cardiac biomarkers (Figure 1). These results may have been partly influenced by haemolysis.
Conclusion
These findings suggest that PFA systems differ in their impact on myocardial injury, potentially influenced by device type and the number of applications. Understanding these differences may assist in selecting the optimal PFA system for specific AF patients, such as those with renal dysfunction.