Comparison of hemolysis with different pulsed field ablation systems

Abstract

Background: Hemolysis is one of the unique complications of pulsed field ablation (PFA), but the differences in hemolysis between the different PFA systems are not well understood.

Objective: This study aimed to investigate the differences in hemolysis between 2 PFA systems.

Methods: We included patients who underwent PFA of atrial fibrillation (PulseSelect, 38; Farapulse, 38) and those who underwent cryoballoon ablation (14 patients) as a control. The free hemoglobin levels before and after the procedure, as well as the postprocedure hemolysis and myocardial injury biomarkers within 24 hours, were measured.

Results: There was no significant difference in the total number of applications between PulseSelect and Farapulse (median 53 [50-58] vs median 53 [46-60], P = .868). The free hemoglobin increased from a median of 0.01 (0.00-0.01) to 0.03 (0.02-0.03) in the PulseSelect group and from 0.01 (0.01-0.02) to 0.06 (0.05-0.06) in the Farapulse group. Farapulse had significantly higher levels of hemolysis biomarkers, including lactate dehydrogenase, total bilirubin, and free hemoglobin, than PulseSelect, and a greater number of patients with low-level haptoglobin was observed with Farapulse than PulseSelect (P < .001). No significant difference in the hemolysis biomarkers was observed between PulseSelect and cryoballoon ablation. Myocardial injury biomarkers exhibited significantly higher creatine kinase levels for both PulseSelect and Farapulse than cryoballoon, but no differences were observed between the 2 PFA systems. No patients experienced acute kidney injury in any cohort.

Conclusion: The degree of hemolysis may differ between the PFA systems. Further investigation might be necessary to determine the safe number of PFA applications for each PFA system.

Keywords: Circular; Complication; Electroporation; Hemolysis; Pentaspline; Pulsed electrical field.