Differential biomarker responses of hemolysis, inflammation, and myocardial injury after pulsed-field pulmonary vein isolation: balloon-in-basket vs. circular catheter systems.

BACKGROUND

Pulsed-field ablation (PFA) is a non-thermal energy source for pulmonary vein isolation (PVI). Data comparing the biological impact of different PFA technologies remain limited. This study assessed changes in biomarkers of hemolysis, inflammation, and biochemical myocardial injury using two PFA systems: a balloon-in-basket (BiB) and a circular catheter (PS).

METHODS

This prospective, single-center, non-randomized study enrolled consecutive patients undergoing first-time PVI. leukocytes, C-reactive protein (CRP), platelets, lactate dehydrogenase (LDH), haptoglobin, total bilirubin, troponin T, creatine kinase (CK), myoglobin, creatinine, and estimated glomerular filtration rate (eGFR) were before and 16-18 h after ablation.

RESULTS

Forty patients were included (BiB n = 20, PS n = 20). Baseline characteristics were comparable. Acute PVI was achieved in all cases. BiB required fewer applications (16 vs. 32, p < 0.001), more contrast (45 vs. 30 mL, p < 0.001), and had longer procedure and LA dwell times (p < 0.001). Both systems caused significant increases in leukocytes, CRP, LDH, troponin, and CK without inter-group differences. Haptoglobin decreased significantly in both, more pronounced with PS (Δ -13 vs. -4 mg/dL, p = 0.090). Renal function remained stable overall, with one PS patient developing an acute kidney injury. In the BiB group, Δ-Hemoglobin correlated inversely with application number (p = 0.046). In the PS group, Δ-Troponin and Δ-CK correlated positively (p < 0.05).

CONCLUSION

Despite comparable overall biomarker responses, a numerically greater, non-significant haptoglobin decline and an isolated, likely multifactorial transient AKI in the PS group may suggest differences in biomarker responses, warranting further investigation in larger studies. However, the clinical relevance of these findings remains uncertain.