Biochemical changes
The two energy sources also differ in terms of the level of inflammation
produced, being the concentration of high sensitive Troponin 1 (hs TnI)
significantly higher after PFA applications than RF ablation (625 ± 138
pg/ml vs 148 ± 36 pg/ml). Unfortunately, the authors did not provide any
information about the Troponin concentration over time after the
ablation (time-related), which could have given additional and critical
data on the degree of inflammatory response. This is a reflection of the
entity of tissue disruption and parallels the demonstration of an
extended area of lesion. These data come from a minority of patients,
but they likely express the true scenario in relation to the specific
energy source applied. In this regard, similar results are achieved when
cryoenergy is applied to myocardial tissue, suggesting a more extensive
inflammatory process than that produced by point-by-point RF
applications (6), suggesting that energy sources with different
biochemical process than RF current produce a greater inflammatory
response. Again, is there any robust clinical data that an extensive
inflammatory process is followed by a better clinical outcome? Or the
hypothetical better clinical outcome could be achieved with an extensive
antral lesion regardless the modality of ablation employed?
Hypothetically, if the area of lesion provided by RF balloon is
comparable to that produced by PFA, will the clinical outcome be not
significantly different?