Does sex shape the biological footprint of balloon-in-basket pulsed field ablation-guided pulmonary vein isolation? A biomarker analysis.

BACKGROUND

The balloon-in-basket pulsed field ablation (BiB-PFA) system is a novel modality that achieves myocardial-selective ablation with minimal collateral tissue injury. Sex-related differences in biomarker responses following BiB-PFA-guided pulmonary vein isolation (PVI) for atrial fibrillation (AF) remain unclear.

OBJECTIVE

We aimed to investigate sex-based differences in peri-procedural biomarker responses and procedure-related complications among patients undergoing PVI alone using the BiB-PFA system.

METHODS

We retrospectively analyzed patients undergoing initial PVI with the BiB-PFA system between January 2024 and March 2026. Peri-procedural inflammatory, myocardial injury, hemolysis, and renal biomarkers were assessed pre-ablation and on the first post-procedural day. Sex-based differences in biomarker changes (Δ = post - pre) and procedural safety outcomes were compared.

RESULTS

A total of 50 patients were included (50% female). Baseline characteristics and procedural parameters were comparable between groups. Δ values in inflammatory markers (Δwhite blood cell count: P = 0.813; ΔC-reactive protein: P = 0.343), myocardial injury markers (Δcreatine kinase: P = 0.261; Δtroponin T: P = 0.078), hemolysis markers and renal function parameters (Δtotal bilirubin: P = 0.160; Δhaptoglobin: P = 0.104; Δestimated glomerular filtration rate: P = 0.984; Δmyoglobin: P = 0.258) did not differ significantly between female and male patients. Procedure-related complications were rare and showed no sex-related differences.

CONCLUSIONS

No statistically significant sex-related differences were detected in peri-procedural biomarker responses or observed procedural complications following BiB-PFA-guided PVI.