{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:38:33Z","timestamp":1788853113905,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Background: Thromboembolic events, though infrequent, remain a significant complication of atrial fibrillation (AF) ablation, largely related to endothelial damage. Cryoballoon (CB) and radiofrequency ablation can induce pro-coagulant responses, whereas pulsed-field ablation (PFA), a novel non-thermal electroporation-based technique, has shown tissue selectivity with potential endothelial-sparing effects. Methods: We aimed to compare PFA and second-generation CB ablation regarding endothelial injury in patients with paroxysmal AF. In this single-center prospective observational study, 25 patients with paroxysmal drug-refractory AF underwent pulmonary vein isolation using either a pentaspline PFA catheter (n = 14) or a second-generation CB catheter (n = 11). Circulating von Willebrand factor antigen (vWF) levels were assessed before and after ablation as a biomarker of endothelial damage, alongside routine laboratory and echocardiographic parameters. Procedural characteristics were also analyzed. Results: Baseline demographic, clinical, and echocardiographic data were comparable between groups. PFA was associated with significantly shorter skin-to-skin procedure time (59 vs. 94 min, p = 0.005) and left atrial dwell time (44 vs. 79 min, p &lt; 0.001) compared with CB ablation. Importantly, vWF levels decreased significantly after PFA (\u22127.6%, p = 0.007), while CB ablation showed a non-significant increase (+9.5%, p = 0.155). The between-group difference in percent change of vWF was statistically significant (\u22125.6% vs. +8.3%, p = 0.006). Conclusions: PFA was associated with reduced endothelial injury and shorter procedural times compared with CB ablation, suggesting a potential advantage in lowering thromboembolic risk. These findings support the concept of PFA as an \u201cendothelial sparing\u201d ablation modality. However, the PFA procedure was associated with a significantly greater extent of myocardial injury, as reflected in circulating high-sensitivity cardiac troponin T values, compared to CB ablation (p = 0.007). Larger, randomized studies are warranted to confirm these results and evaluate long-term clinical outcomes.<\/jats:p>","DOI":"10.3390\/pathophysiology32040060","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T10:56:45Z","timestamp":1762513005000},"page":"60","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pulsed-Field Ablation Is Associated with Lower Endothelial Injury and Procedure Time Compared to Cryoballoon Ablation in Paroxysmal Atrial Fibrillation"],"prefix":"10.3390","volume":"32","author":[{"given":"Josip","family":"Katic","sequence":"first","affiliation":[{"name":"Cardiovascular Diseases Department, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ante","family":"Anic","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Department, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7266-2087","authenticated-orcid":false,"given":"Toni","family":"Breskovic","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Department, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4878-8146","authenticated-orcid":false,"given":"Josip Andelo","family":"Borovac","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Department, University Hospital of Split (KBC Split), 21000 Split, Croatia"},{"name":"Department of Health Studies, University of Split, 21000 Split, Croatia"},{"name":"Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branka","family":"Kresic","sequence":"additional","affiliation":[{"name":"Department of Health Studies, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5584-3182","authenticated-orcid":false,"given":"Daniela","family":"Supe-Domic","sequence":"additional","affiliation":[{"name":"Department of Health Studies, University of Split, 21000 Split, Croatia"},{"name":"Department of Medical Laboratory Diagnostics, University Hospital of Split (KBC Split), 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9696-3359","authenticated-orcid":false,"given":"Marko","family":"Kumric","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1634-0635","authenticated-orcid":false,"given":"Josko","family":"Bozic","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zrinka","family":"Jurisic","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases Department, University Hospital of Split (KBC Split), 21000 Split, Croatia"},{"name":"Department of Internal Medicine, University of Split School of Medicine, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/jce.13476","article-title":"Anticoagulation use and clinical outcomes after catheter ablation in patients with persistent and longstanding persistent atrial fibrillation","volume":"29","author":"Liang","year":"2018","journal-title":"J. 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