NEMESIS-PFA: Investigating Collateral Tissue Injury Associated with Pulsed Field Ablation

Overview

Published by JACC: Clinical Electrophysiology on April 24, 2025.
Study conducted by multiple authors including Dhanunjaya Lakkireddy, Aashish Katapadi, Jalaj Garg, and more.
Focuses on collateral tissue injury associated with Pulsed Field Ablation (PFA).

Previous evidence suggests reduced complications with PFA.
Concerns exist about non-target tissue collateral damage due to electroporation effects.
Collateral damage may vary significantly between different systems.

NEMESIS-PFA is a multicenter, observational registry.
Includes patients who underwent AF ablation starting March 2024.
Systems used: circular multielectrode array, spherical, pentaspline, variable loop catheter, or radiofrequency ablation (RFA).
Parameters assessed: procedural characteristics, myocardial injury biomarkers, hemolytic anemia, renal function, and left atrial (LA) function.

Sample: 871 patients, average age 68.9 years, 70.8% male, paroxysmal AF in 59.4%.
CHA2DS2VASc score: 3.3.
87.1% underwent PFA with different catheters (pentaspline, circular multielectrode, spherical, variable loop).
Significant post-procedural changes in biomarkers such as troponin, LDH, and haptoglobin, all showing higher levels in PFA compared to RFA.
Biomarker changes were dose-dependent and varied across PFA systems.
Significant change in LA ejection fraction between PFA and RFA.

Current PFA technologies are linked to higher troponin leak, hemolysis, renal dysfunction than RFA.
PFA is becoming more mainstream, necessitating further studies on short and long-term implications.
NEMESIS-PFA highlights worse collateral effects with PFA compared to RFA, requiring additional investigation.

Published by Elsevier on behalf of The American College of Cardiology Foundation.
DOI: 10.1016/j.jacep.2025.04.017