CONGRESS ABSTRACT

Background: Very-high-power-short duration (vHPSD) catheters are associated with less irrigation fluid load than standard (STD RF) ablation catheters. However, the impact of this fluid reduction on biomarkers in pulmonary vein isolation (PVI) for atrial fibrillation (AF) remains unknown. Methods and aim:  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 aimed to assess the impact of vHPSD catheter compared to an STD catheter (respectively irrigation of 8 vs.15 ml/min during ablation) on biomarker alterations. Results The study included 83 consecutive patients (59 males [71.1%], mean age 62.6±11 years), with vHPSD catheters used in 53 cases (63.9%). No significant baseline differences were observed between groups. Fluid irrigation resulted significantly lower with vHPSD catheter than STD RF (434.8 ± 105.6 vs. 806.6 ± 256.5 ml, p<0.001). Correspondingly, BNP variation was significantly lower in the vHPSD group than in the STD RF group, both in absolute change (12 [IQR -9–47] pg/mL vs. 44.5 [IQR 21–88.7] pg/mL, p=0.002) and percentage change (16.3 [IQR -13.2–108.6] % vs. 84.1 [IQR 32.5–172.1] %, p=0.012). When considering absolute values, a statistically significant increase in BNP was found only in the STD catheter group (from 52 [IQR 35.2 – 113.5] to 113 [IQR 66.7 – 189.5] pg/mL, p < 0.001), whereas no significant increase was observed in the vHPSD group (p = 0.06). CRP levels increased post-PVI in both groups, but the delta was significantly lower in the vHPSD group (p=0.025). No significant differences in postprocedural hsTnI were detected between groups. Conclusion: 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.