# Biomarker response to balloon-in-basket pulsed field ablation: does posterior wall isolation matter?

## TL;DR

This study finds that adding posterior wall isolation to a PFA procedure does not increase biological stress markers compared to pulmonary vein isolation alone.

## Contribution

The study is the first to compare biomarker responses between PVI and PVI plus PWI using BiB-PFA technology.

## Key findings

- Both PVI and PVI plus PWI caused significant increases in inflammation, myocardial injury, and hemolysis markers.
- PVI plus PWI required more ablation applications but did not lead to greater biomarker release than PVI alone.
- The results support the biological safety of adding PWI to PVI during BiB-PFA procedures.

## Abstract

A 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.

In 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.

A 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).

BiB-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.

Infographic summarizing a study on biomarker response to Balloon-in-Basket Pulsed Field Ablation, including colorful anatomical 3D renderings, methods, results, and conclusion boxes. Methods detail study design, patient numbers, and biomarkers assessed. Results report one hundred percent acute success, more applications needed for PVI plus PWI, and no significant differences in inflammation, myocardial, or hemolysis markers. Conclusion states BiB-PFA PWI is safe with no intergroup biomarker differences.