Physiological Tissue Response to Pulsed-Field Ablation for Atrial Fibrillation: Insights from Biomarker Kinetics.

Troponin-T increased significantly from near-zero baseline values to markedly elevated levels immediately and 24 hours after PFA procedure.

• Repeated-measures ANOVA demonstrated significant time effects for troponin-T (p < 0.001)
• Significant interactions were found between troponin-T levels and ablation burden
• The study cohort consisted of 52 patients (73% men, 27% women)
• 52% had paroxysmal AF and 48% had persistent AF
• Mean left ventricular ejection fraction was 55 ± 7%

CK and CK-MB rose several-fold following PFA with only partial decline observed after the procedure.

• Repeated-measures ANOVA demonstrated significant time effects for CK and CK-MB (p < 0.001)
• Significant interactions were found between CK/CK-MB levels and ablation burden
• Unlike troponin-T, CK and CK-MB showed only partial (not full) decline in the post-procedural measurement period
• Mean ablation burden was 67 ± 23 applications per procedure

The number of PFA applications correlated positively with late CK and CK-MB values, indicating that myocardial biomarker load scales with procedural intensity.

• Positive correlation was observed between ablation application count and late post-procedural CK values
• Positive correlation was also observed between ablation application count and late post-procedural CK-MB values
• Mean ablation burden was 67 ± 23 applications per procedure
• This relationship suggests a dose-response pattern between procedural intensity and myocardial biomarker release

Renal biomarkers urea and creatinine remained stable throughout the procedure, indicating preserved renal function without acute kidney injury.

• Both urea and creatinine were measured before and after ablation
• No significant changes in renal biomarkers were detected, in contrast to the marked changes seen in myocardial markers
• The findings indicate absence of acute kidney injury following PFA
• Mean left atrial diameter was 45 ± 7 mm in the study cohort

Substantial biochemical myocardial injury induced by PFA does not translate into measurable renal dysfunction.

• The study concurrently analyzed both myocardial (troponin-T, CK, CK-MB) and renal (urea, creatinine) markers
• Myocardial markers showed marked elevation while renal markers remained stable
• This dissociation supports the characterization of PFA as having 'myocardial selectivity and reduced collateral tissue injury'
• Findings align with current literature showing 'extensive myocardial biorelease after PFA but favorable extracardiac safety'