Differential inflammatory and myocardial biomarker response after pulsed field ablation for atrial fibrillation using balloon-in-basket vs pentaspline catheters

BACKGROUND: Pulsed field ablation (PFA) is a nonthermal technique for pulmonary vein isolation (PVI) in atrial fibrillation, offering lesion selectivity with minimal collateral damage. Despite its nonthermal nature, systemic inflammatory and myocardial responses may occur. Catheter design could modulate these effects.

OBJECTIVE: The purpose of this study was to compare inflammatory and myocardial biomarker responses after PFA using balloon-in-basket vs pentaspline catheter systems.

METHODS: This prospective, nonrandomized, single-center study involved venous blood sampling before and the morning after PFA-based PVI using either catheter type. Biomarkers analyzed included leukocytes, C-reactive protein (CRP), platelets, troponin T, creatine kinase (CK), CK-MB, and myoglobin.

RESULTS: Eighty patients were included (balloon-in-basket: n = 40; pentaspline: n = 40). Baseline characteristics were comparable. All patients achieved acute and first-pass PVI. The balloon-in-basket group required fewer PFA applications (16 vs 32; P < .001). Leukocyte and CRP rose in both groups, more so with the pentaspline catheter (Δ leukocytes: 0.6 × 109/L vs 1.9 × 109/L, P = .026; Δ CRP: 3.4 mg/L vs 5.1 mg/L, P = .074). Platelet count decreased more in the balloon-in-basket group (Δ platelets -11 × 109/L vs -1 × 109/L; P = .005), while CK increased more in this group (Δ CK 219.5 U/L vs 97.0 U/L; P < .001). Troponin T, CK-MB, and myoglobin changes were similar.

CONCLUSION: Balloon-in-basket and pentaspline PFA catheters induce distinct inflammatory and myocardial biomarker profiles after PVI. The observed differences in leukocyte, CRP, and platelet responses highlight design-specific biological effects. These findings may support informed catheter selection and help guide postprocedural monitoring strategies.