Hemolysis biomarkers after pulmonary vein isolation using three different pulsed-field ablation systems

Pulsed-field ablation (PFA) is a novel ablation modality offering tissue-selective electroporation thereby minimizing damage to surrounding tissue. While PFA for the treatment of atrial fibrillation (AF) has been shown to be safe and effective, multiple cases of PFA-mediated hemolysis have been recently reported. Data comparing hemolysis using different PFA systems is scarce.

To assess releases in hemolysis biomarkers after pulmonary vein isolation (PVI) using three different PFA systems.

The study enrolled consecutive patients undergoing PVI between August 2024 and December 2024 at a Swiss tertiary centre. Hemolysis biomarkers were measured at baseline and the day after the procedure. PFA was performed using a pentaspline catheter-system (PCS, FARAPULSE, Boston Scientifc), a loop catheter-system (LCS, PulseSelect, Medtronic) and a variable-loop circular catheter (VLCC, VARIPULSE, Biosense Webster).

175 patients were included (age 68 [60 - 75] years, 33% female, 59% paroxysmal AF). 95 of the patients were treated with PCS, 40 with LCS, 40 with VLCC, respectively. Number of applications were as follows: 34, 34 and 54 (18 ablations) for the PCS, LCS and VLCC PFA system, respectively. Pre-interventional hemolysis biomarkers did not differ between the three groups. Post-interventional total bilirubin, indirect bilirubin, LDH were significantly higher and haptoglobin was significantly lower in the PCS group (14.7 [10.7 - 21.2], 8.8 [6.7 - 12.5] µmol/L, 275.5 [249.5 - 320.0] U/L and 0.5 [0.3 - 0.8] g/L) compared to the LCS group (12.2 [9.4 - 14.9], 7.2 [5.8 - 9.9] µmol/L, 250.0 [209.0 - 275.0] U/L and 0.8 [0.5 - 1.1] g/L; p=0.01, 0.034, 0.003 and 0.012). No significant differences were found between the PCS and VLCC and the LCS and VLCC group (12.4 [10.1 - 15.7], 7.8 [5.9 - 9.5] µmol/L, 219.0 [195.0 - 247.0] U/L and 0.7 [0.4 - 1.1] g/L, Figure).

In patients undergoing PFA for the treatment of AF, we found significant differences in hemolysis biomarkers between three different PFA systems. Further studies are warranted to confirm these findings and assess impact on the occurrence of acute kidney injury, anemia, and hematuria.Figure