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Related Experiment Video

Updated: May 22, 2025

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation
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NEMESIS-PFA: Investigating Collateral Tissue Injury Associated With Pulsed Field Ablation.

Dhanunjaya Lakkireddy1, Aashish Katapadi1, Jalaj Garg2

  • 1Kansas City Heart Rhythm Institute, Overland Park, Kansas, USA.

JACC. Clinical Electrophysiology
|May 20, 2025
PubMed
Summary

Pulsed field ablation (PFA) shows increased myocardial injury, hemolysis, and renal dysfunction compared to radiofrequency ablation (RFA). Further research is needed to understand the long-term effects of PFA technologies.

Keywords:
acute kidney injuryatrial fibrillationhemolysisleft atrial functionmyocardial injurypulsed field ablationradiofrequency ablation

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Pulsed field ablation (PFA) shows promise for reduced complications but potential non-target tissue damage from electroporation is not well understood.
  • Variability in collateral damage may exist between different PFA systems.

Purpose of the Study:

  • To evaluate the collateral effects of pulsed field ablation (PFA) compared to radiofrequency ablation (RFA).

Main Methods:

  • The NEMESIS-PFA registry included 871 patients undergoing atrial fibrillation ablation with PFA or RFA systems.
  • Assessed procedural characteristics, biomarkers for myocardial injury, hemolytic anemia, renal function, and left atrial function.

Main Results:

  • PFA procedures resulted in significantly higher troponin, lactate dehydrogenase, and haptoglobin changes compared to RFA.
  • These biomarker changes were dose-dependent and varied across different PFA systems.
  • Left atrial ejection fraction significantly decreased after PFA compared to RFA.

Conclusions:

  • Current PFA technologies are linked to greater troponin leak, hemolysis, and renal dysfunction than RFA.
  • Long-term implications of these PFA-associated effects require further investigation as the technology becomes more widespread.