Pulsed Field Ablation Is Associated With Fewer Post-Procedural Pericardial Inflammatory Symptoms Compared With...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial fibrillation (AF) ablation can cause pericardial inflammation, leading to chest pain and delayed recovery.
• Pulsed field ablation (PFA), a non-thermal method, may minimize collateral damage to the pericardium.
• Radiofrequency ablation (RFA) is a common thermal ablation technique for AF.

Purpose of the Study:

• To compare the incidence of post-procedural pericardial inflammatory symptoms and recovery between PFA and RFA for AF ablation.
• To evaluate chest pain severity, anti-inflammatory medication use, and hospital stay duration in patients undergoing PFA versus RFA.
• To assess biomarkers of inflammation and myocardial injury following PFA and RFA procedures.

Main Methods:

• A single-center observational study prospectively collected data from 150 patients undergoing AF ablation.
• Patients were divided into two groups: focal PFA (n=75) and RFA (n=75).
• Outcomes included pericardial symptoms, chest pain scores, anti-inflammatory use, hospital stay, CRP, and hs-TnT levels.

Main Results:

• PFA was associated with significantly less frequent post-procedural chest pain (5.3% vs. 32%, p<0.001) compared to RFA.
• The PFA group required less anti-inflammatory therapy (2.7% vs. 20%, p=0.001) and had a shorter hospital stay (1 day vs. 2 days, p=0.03).
• While hs-TnT levels were higher after PFA, CRP levels were similar, and procedure time was shorter with PFA (86 min vs. 122 min, p<0.001).

Conclusions:

• Pulsed field ablation (PFA) demonstrates a favorable safety profile regarding pericardial inflammation post-atrial fibrillation ablation.
• PFA leads to reduced chest pain, decreased need for anti-inflammatory drugs, and faster patient recovery compared to RFA.
• These findings support PFA as a potentially superior modality for AF ablation, prioritizing patient comfort and recovery.