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?