Impact of very-high-power-short duration catheters on fluid overload biomarker after atrial fibrillation ablation

Very-high-power-short duration (vHPSD) catheters are associated with less irrigation fluid load then standard (STD) ablation catheters. However, the impact of this fluid reduction on biomarkers in pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unknown

Biomarkers of heart failure, myocardial injury, and systemic inflammation status as Brain Natriuretic Peptide (BNP), high sensitivity Troponin I (hsTnI), and C-reactive protein (CRP) were collected pre- and post-procedure of PVI for symptomatic AF. The study aims to assess the impact of using a vHPSD catheter compared to a STD catheter (respectively irrigation of 8 vs.15 ml/min during ablation) on biomarker alterations, particularly BNP, following PVI. A wide-area circumferential ablation lesion was performed based on ablation index criteria (CLOSE protocol) for the STD catheter group, whereas for the vHPSD group, an energy of 90W for 4 seconds was applied on the posterior LA wall.

The study included 131 consecutive patients (91 males [69.5%]) with a mean age of 64.2±10.5 years. The vHPSD catheter for ablation was used in 78 (59.5%). No statistically significant baseline differences were detected between the two groups. Fluid irrigation resulted significantly lower with vHPSD catheter than STD (458.8±19.9 vs. 755.7±51.1 ml, p<0.001). Correspondingly, the variation in BNP before and after the procedure was higher in the STD catheter group compared to the vHPSD group (Figure 1), both in absolute and percentage changes (84.4±111.6 pg/mL vs. 13.5±65 pg/mL, p < 0.001, and 386.1 vs. 53.5%, p = 0.04, respectively). When considering absolute values (Figure 2), a statistically significant increase in BNP was found only in the STD catheter group (from 83.7±84.5 to 168.2±154.3 pg/mL, p < 0.001), whereas no significant increase was observed in the vHPSD group (from 116.5±195.3 to 130.4±197.7 pg/mL, p = 0.085). A CRP values increase was found in both groups (from 0.19±0.2 to 1.17±0.6 mg/dl, p<0.001 for vHPSD; from 0.15±0.1 to 1.48±1.2 mg/dl, p<0.001), but the delta in variation resulted statistically significant only for STD catheters (1.32±1.2 mg/ml for STD vs. 0.95±0.7 mg/ml for vHPSD, p=0.04). A significant hsTnI increase was found in both groups after the PVI (p<0.001), but there were no significant differences between the groups in terms of absolute or percentage change, or in absolute values (p = 0.19, p = 0.46, and p = 0.74, respectively). No significant differences in pre- and post-procedure changes were found between the vHPSD and STD catheter groups for electrolytes, creatinine, hematocrit, or white blood cell count.

The use of a vHPSD catheter is associated with reduced fluid irrigation and a correspondingly smaller increase in BNP, a biomarker indicative of fluid overload and heart failure. This effect could be particularly significant for patients with heart failure, as it may help minimize procedure-related fluid overload.