Clinical Implications of Hemolysis after Pulsed Field Ablation - What Can We Learn from Benchtop Models and Preclinical Experiments.

Pulsed field ablation (PFA) has emerged as a transformative technology for cardiac ablation due to its efficiency and favorable safety profile. However, intravascular hemolysis has been increasingly recognized adverse effect across preclinical and clinical studies, infrequently progressing to acute kidney injury (AKI). The mechanisms, determinants, and clinical relevance of PFA-related hemolysis remain incompletely understood. Herein, we review the pathophysiology of PFA-related hemolysis and measures to mitigate its occurrence, discuss the biomarker-related changes and perform a comprehensive review of preclinical hemolysis models. Continued development of physiological benchtop models including numerical models to better understand PFA-related hemolysis and translation to bedside is needed. Furthermore, transparent cross-platform evaluation of hemolysis will be critical in the light of rapidly evolving PFA technologies.