Inflammatory and Myocardial Biomarker Response Following Pulmonary Vein Isolation: Cryoballoon Versus Balloon-in-Basket Pulsed Field Ablation

Abstract

Background: Cryoballoon ablation (CB) is a well-established thermal technique for pulmonary vein isolation (PVI), while balloon-in-basket pulsed field ablation (BiB-PFA) represents a novel non-thermal alternative. Both single-shot systems may trigger systemic inflammation and myocardial injury, yet direct comparisons are lacking. This study aimed to compare inflammatory and myocardial biomarker responses following first-time PVI using CB or BiB-PFA. Methods: In this prospective, single-center study, 100 patients undergoing PVI for symptomatic paroxysmal or persistent atrial fibrillation (AF) were enrolled (CB: n = 50; BiB-PFA: n = 50). Venous blood samples were collected before and on the morning after ablation to assess leukocytes, C-reactive protein (CRP), platelets, troponin T, creatine kinase (CK), myoglobin, creatinine, and estimated glomerular filtration rate. Baseline characteristics, procedural data, and acute success were analyzed. Results: Patients in the CB group were older (74 vs. 65 years; p = 0.01) and had higher CHA₂DS₂-VAcore (3.0 vs. 2.0; p = 0.009). Acute PVI was achieved in all cases CB was associated with greater increases in leukocytes (Δ2.5 vs. 1.1 × 10⁹/L; p = 0.05) and CRP (Δ5.8 vs. 3.4 mg/L; p = 0.02), whereas BiB-PFA showed higher rises in CK (Δ217 vs. 103 U/L; p = 0.01) and troponin T (Δ1129 vs. 614.5 ng/L; p = 0.01). No significant correlation was found between energy delivery and biomarker changes. Conclusion: CB and BiB-PFA elicit distinct systemic responses. CB provoked stronger inflammatory activation, while BiB-PFA caused greater myocardial biomarker release, suggesting energy- and device-specific effects.