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. 2025 Jul 25;13(8):1828.
doi: 10.3390/biomedicines13081828.

Comparative Effects of Pulsed Field and Radiofrequency Ablation on Blood Cell Parameters During Pulmonary Vein Isolation

Lucio Addeo  1 , Federica Di Feo  2   3 , Mario Vaccariello  2   3 , Alfonso Varriale  1 , Benedetta Brescia  1 , Davide Bonadies  2   3 , Stefano Nardi  2 , Luigi Argenziano  2 , Vittoria Marino  2 , Vincenza Abbate  1 , Luigi Cocchiara  1 , Pasquale Guarini  4 , Laura Adelaide Dalla Vecchia  5 , Francesco Donatelli  6
Affiliations

Comparative Effects of Pulsed Field and Radiofrequency Ablation on Blood Cell Parameters During Pulmonary Vein Isolation

Lucio Addeo et al. Biomedicines. .

Abstract

Background: Pulsed field ablation (PFA) is a novel non-thermal modality for pulmonary vein isolation (PVI) in atrial fibrillation (AF), offering myocardial selectivity through irreversible electroporation while sparing surrounding structures. However, concerns have emerged regarding potential subclinical hemolysis, reflected by alterations in biochemical markers such as lactate dehydrogenase (LDH). Methods: We conducted a retrospective, single-center study involving 249 patients undergoing PVI: 121 treated with PFA (PulseSelect or FARAPULSE) and 128 with radiofrequency (RF) ablation (PVAC catheter). Laboratory parameters were assessed at baseline, post-procedure, and at discharge, including hemoglobin, hematocrit, red blood cell (RBC) count, platelet count, creatinine, and LDH. The primary endpoint was the variation in blood cell indices; the secondary endpoint was the evaluation of LDH and hematocrit changes. Statistical analysis included t-tests and chi-square tests. Results: Baseline characteristics and pre-procedural labs did not differ significantly between groups. No significant changes in hemoglobin, hematocrit, RBC count, platelet count, or creatinine were observed post-ablation or at discharge. However, LDH levels significantly increased in the PFA group both post-procedurally and at discharge (p < 0.001), without concurrent changes in other blood cell parameters. Conclusions: PFA and RF ablation yield comparable hematological profiles after PVI, with no significant impact on key blood cell parameters. Nonetheless, the consistent rise in LDH levels in the PFA group suggests mild, subclinical hemolysis or tissue injury due to more extensive lesions. While supporting the hematologic safety of PFA, these findings underscore the need for further studies to assess the clinical significance of these biochemical alterations, particularly in high-risk patients or extensive ablation settings.

Keywords: atrial fibrillation; blood cell parameters; hemolysis; lactate dehydrogenase; post-procedural course; pulmonary vein isolation; pulsed field ablation; radiofrequency ablation.

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Conflict of interest statement

The authors report no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Changes in blood cell and biochemical parameters post-ablation in PFA and RF groups. The reported p-values reflect intergroup comparisons at the specified time points.
See this image and copyright information in PMC

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