Evaluation of the risk of hemolysis using the circular array pulsed field ablation catheter in the management of atrial fibrillation.

BACKGROUND

Procedure-related complications such as intravascular hemolysis have been reported with pulsed field ablation (PFA). However, data for the circular array catheter are limited.

OBJECTIVE

This study aimed to quantify intravascular hemolysis after atrial fibrillation (AF) ablation with the circular array catheter and compare outcomes with alternate PFA systems.

METHODS

Consecutive patients undergoing AF ablation with PFA at a single center underwent routine postablation bloodwork collection of hemolysis and renal markers. Data were evaluated according to AF ablation strategy (pulmonary vein isolation [PVI] vs PVI + posterior wall isolation) and between PFA technologies. Predictors of significant hemolysis (plasma free hemoglobin [fHb] >0.5 g/L]) were assessed using logistic regression.

RESULTS

A total of 224 patients (209 circular array; 15 pentaspline) were evaluated. The circular array catheter resulted in mild hemolysis (median fHb 0.38 g/dL). The fHb was higher with PVI + posterior wall isolation than PVI alone (0.42 g/dL vs 0.32 g/dL; P < .001) and correlated moderately with lesion number (r = 0.32; P < .001). Compared with the circular array catheter, ablation using the pentaspline resulted in significantly higher fHb (0.38 g/dL vs 0.76 g/dL; P < .001). No patient required blood transfusion or dialysis. Multivariable logistic regression identified lesion burden (odds ratio [OR] 1.04 per lesion; 95% confidence interval [CI] 1.01-1.06; P = .003), pentaspline catheter (OR 10; 95% CI 2.57-39.56; P = .001), and additional ablation, such as posterior wall (OR 2.41; 95% CI 0.98-5.94; P = .056) as predictors of hemolysis.

CONCLUSION

The circular array catheter is associated with mild, lesion number-dependent hemolysis and demonstrates a more favorable hemolytic profile than the pentaspline catheter. Given that haptoglobin and renal parameters take hours to change, we cannot estimate the effects on these parameters or their clinical relevance from an immediate blood draw.