Association Between the Change in Interleukin-6 Levels and Early Recurrence of Atrial Fibrillation: A Comparison of Pulsed Field Ablation and Radiofrequency Ablation

Abstract

Background

Early recurrence of atrial fibrillation (ERAF) within the 3-month blanking period is associated with procedural inflammation and increased risk of late recurrence. Pulsed field ablation (PFA) reportedly has a lower ERAF rate than radiofrequency ablation (RFA), but the underlying inflammatory mechanisms remain unclear.

Methods

We compared 23 patients undergoing atrial fibrillation ablation (PFA: n = 16; RFA: n = 7). Perioperative changes in inflammatory markers, myocardial injury markers, hemolysis markers, and the incidence of ERAF were analyzed.

Results

PFA exhibited significantly greater myocardial injury and hemolysis, but markedly lower systemic inflammation than RFA, characterized by lower Δinterleukin-6 (IL-6) levels (4.6 ± 1.7 vs. 8.1 ± 3.8 pg/mL, p = 0.008). ERAF occurred more frequently in RFA (3/7, 43% vs. 1/16, 6%, p = 0.033), which was accompanied by significantly higher ΔIL-6 levels (9.1 ± 4.2 vs. 4.9 ± 2.3 pg/mL, p = 0.010). Multivariate logistic regression analysis identified ΔIL-6 as an independent predictor of ERAF (OR 2.158, 95% CI 1.125–13.020, p = 0.013).

Conclusions

PFA induces less systemic inflammation than RFA, despite causing greater myocardial injury. This reduced inflammatory response is independently associated with the lower incidence of ERAF.