Thromboinflammation and hemolysis after pulsed field ablation with a pentaspline catheter: Clinical predictors, renal safety, and rhythm outcomes.

BACKGROUND

Hemolysis was recently identified as a side effect of pulsed field ablation (PFA), which raised renal safety concerns. Further systemic effects of PFA-induced hemolysis remain unknown.

OBJECTIVE

This study aimed to investigate the thromboinflammatory potential of PFA and the systemic biological effects of PFA-induced hemolysis.

METHODS

We prospectively included 60 patients with paroxysmal atrial fibrillation receiving pulmonary vein isolation using a pentaspline PFA system (n = 30) or radiofrequency ablation (RFA) (n = 30). Biomarkers of inflammation, platelet activation, endothelial cell damage, hemolysis, and renal function were analyzed at 3 timepoints. Pericarditis, early recurrences, and 6-month rhythm outcomes were further assessed.

RESULTS

Intravascular hemolysis was detected in 100% of PFA-treated patients after a mean of 42.8 ± 3.7 deliveries. Leukocyte release (Δ3.0 ± 2.3 vs 3.6 ± 2.3 × 109/L; P = .254), acute platelet activation, and endothelial cell damage biomarker changes were similar between PFA and RFA. Nitric oxide levels decreased significantly in the PFA group only (-26.5% ± 17.8%; P < .001). Although no acute kidney injury occurred, hemolysis burden was significantly associated with creatinine increase, inflammation, and platelet activation. Female sex was the only independent predictor of significant hemolysis after PFA (odds ratio, 7.8; 95% confidence interval, 1.2-50.2; P = .031). In-hospital pericarditis was lower with PFA (10.0% vs 33.3%; P = .028), whereas early (20.0% vs 26.7%) and late recurrences (6.7% vs 10.0%; all P > .05) were similar between groups.

CONCLUSION

PFA is associated with a similar thromboinflammatory reaction as RFA. PFA-induced hemolysis occurs in all patients and is significantly associated with renal function decline, inflammation, and platelet activation even with limited PFA deliveries. Females are at a higher risk of significant hemolysis after PFA.