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Biomarker response to balloon-in-basket pulsed field ablation: does posterior wall isolation matter?
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DOI：10.3389/fcvm.2026.1733642.png)
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Abstract
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BackgroundA novel balloon-in-basket pulsed field ablation (BiB-PFA) catheter enables efficient pulmonary vein isolation (PVI) and allows posterior wall isolation (PWI) within the same procedure. The incremental biological effect of PWI compared to PVI alone remains uncertain; particularly regarding inflammation; myocardial injury; and hemolysis.MethodsIn this prospective; single-center study; consecutive patients with atrial fibrillation underwent first-time BiB-PFA; either PVI only or PVI plus PWI. Venous blood samples were collected before and one day after ablation. Biomarkers included leukocytes; platelets; hemoglobin; C-reactive protein (CRP); haptoglobin; bilirubin; lactate dehydrogenase (LDH); creatinine; estimated glomerular filtration rate (GFR); myoglobin; creatine kinase (CK); and troponin T.ResultsA total of 60 patients were enrolled (PVI only n = 30; PVI + PWI n = 30). Baseline characteristics were comparable. PVI + PWI required more applications (19 vs. 16; p < 0.001) but had similar procedure time. Both groups showed significant increases in inflammatory (CRP; leukocytes); myocardial (troponin T; CK; LDH; myoglobin); and hemolysis markers (bilirubin; LDH; haptoglobin changes; all p < 0.001). However; the magnitude of biomarker release did not differ between PVI only and PVI + PWI: Δ troponin T (1; 154 vs. 1; 029 ng/L; p = 0.694); Δ CK (217 vs. 197 U/L; p = 0.652); Δ CRP (2.7 vs. 3.4 mg/L; p = 0.475); Δ bilirubin (2.4 vs. 2.8 µmol/L; p = 0.842); Δ creatinine (3.3 vs. 9.0 µmol/L; p = 0.085).ConclusionBiB-PFA PVI provokes systemic responses involving inflammation; myocardial injury; and hemolysis. Adjunctive PWI increases application number but does not further increase biomarker release; supporting the biological safety of PWI.
Keywords:
inflammation
hemolysis
platelets
atrial fibrillation
PVI
myocardial injury
PFA
posterior wall isolation
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