Impact of the ablation technique on release of the neuronal injury marker S100B during pulmonary vein isolation

Abstract

Aims S100B, a well-known damage-associated molecular pattern protein is released acutely by central and peripheral nerves and upon concomitant denervation in pulmonary vein isolation (PVI). We aimed to investigate whether the ablation technique used for PVI impacts S100B release in patients with paroxysmal atrial fibrillation (AF). Methods and results The study population consisted of 73 consecutive patients (age: 62.7 ± 10.9 years, 54.8% males) undergoing first-time PVI with either radiofrequency (RF; n = 30) or cryoballoon (CB; n = 43) for paroxysmal AF. S100B determined from venous plasma samples taken immediately before and after PVI increased from 33.5 ± 1.8 to 91.1 ± 5.3 pg/mL (P < 0.0001). S100B release in patients undergoing CB-PVI was 3.9 times higher compared to patients with RF-PVI (ΔS100B: 21.1 ± 2.7 vs. 83.1 ± 5.2 pg/mL, P < 0.0001). During a mean follow-up of 314 ± 186 days, AF recurrences were observed in 18/71 (25.4%) patients (RF-PVI: n = 9/28, CB-PVI: n = 9/43). Univariate Cox regression analysis indicated that an increase in S100B was associated with higher freedom from AF in follow-up (hazard ratio per 10 pg/mL release of S100B: 0.83; 95% confidence interval: 0.72–0.95; P = 0.007). Conclusion The ablation technique used for PVI has an impact on the release of S100B, a well-established biomarker for neural damage.

Pulmonary Vein Isolation by Pulsed-field Ablation Induces Less Neurocardiac Damage Than Cryoballoon Ablation

“…Resting heart rate increases after thermal PVI by ~10 bpm, which has been attributed to interruption of the physiological control of resting heart rate secondary to damage of neurons in ganglionated plexus innervating the sinus node. 4,5 Our data replicate the expected increase in resting heart rate after CBA, while heart rate did not change after PFA-PVI, potentially attributable to the lesser neuronal damage reflected by lower S100B release.…”

“…A direct causeand-effect relationship between S100B release and heart rate cannot be shown, and other sources of S100B release may contribute to our findings. 4,5 Lower S100B release has also been reported after point-by-point RFA-PVI. 5 Further studies, ideally including randomized allocation to ablation different techniques, are needed to further evaluate the effect of PFA on S100B release, neuronal damage, and autonomic function of the heart.…”

“…4,5 Lower S100B release has also been reported after point-by-point RFA-PVI. 5 Further studies, ideally including randomized allocation to ablation different techniques, are needed to further evaluate the effect of PFA on S100B release, neuronal damage, and autonomic function of the heart.…”

Meta‐analysis of pulsed‐field ablation versus cryoablation for atrial fibrillation

“…Ablation‐induced troponin elevation serves as a reliable indicator of cardiomyocyte injury 32 . S100 protein is expressed by glial cells surrounding autonomic nerves and neurons within ganglionated plexi in the heart, and its release occurs following ablation at the posterior wall of the left atrium 32,33 . In this study, we demonstrate that the increase in high‐sensitive troponin levels was significantly greater after PFA‐PVI.…”

Recurrences after Pulsed Field Ablation of Atrial Fibrillation: Incidence, Mechanisms, Predictors, and Comparison with Thermal Energy

“…Given the proximity of ganglionated plexi with the ostium of pulmonary veins and the non-selective transmural lesions, conventional thermal energy may create bystander damage to such structures. Some studies correlated the thermal energy-induced damage of the ganglionated plexi and the resulting autonomic changes with the long-term success of AF ablation [34].…”