Arrhythmias & electrophysiology
NEMESIS-PFA: Investigating Collateral Tissue Injury Associated With Pulsed Field Ablation
Authors' conclusion
Current PFA technologies are associated with worse troponin leak, hemolysis, and renal dysfunction than RFA. As PFA becomes mainstream, future studies appraising these effects and understanding the short term and long-term implications are needed.
Study context
- Population
- Patients who underwent AF ablation from March 2024 onwards with any approved pulsed field ablation (PFA) system or radiofrequency ablation (RFA)87.1% (n = 773) underwent PFA
- Participants
- 871 patients
- Exposure
- PFA vs RFA
- PFAn = 773
- Outcome
- Postprocedural change in troponin
Main finding
As reported in the abstract
PFA
13,551.0
ng/dL
RFA
127.5
ng/dL
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | PFA | RFA | P value |
|---|---|---|---|
| Postprocedural change in lactate dehydrogenase | 107.5 IU/L | 26.5 IU/L | P < 0.001 |
| Postprocedural change in haptoglobin | −102.0 mg/dL | −33.5 mg/dL | P < 0.001 |
| Change in left atrial ejection fraction | −20.0% | −5.0% | P < 0.001 |
Biomarkers across PFA systems
- There were also significant differences in biomarkers across PFA systems
Baseline characteristics
- Age
- 68.9 ± 10.9 years
- Male
- 70.8%
- Paroxysmal atrial fibrillation
- 59.4%
- CHA2DS2VASC
- 3.3 ± 1.3
Original publication
NEMESIS-PFA: Investigating Collateral Tissue Injury Associated With Pulsed Field Ablation. JACC Clin Electrophysiol. Published 24 April 2025. doi:10.
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