Intravascular hemolysis after pulsed field ablation for atrial fibrillation: A comparative analysis of 3 systems

Intravascular hemolysis after pulsed field ablation (PFA) for atrial fibrillation contributes to renal dysfunction; however, the extent and clinical relevance may differ depending on the ablation system used.

This study aimed to compare the extent of intravascular hemolysis across 3 pulmonary vein isolation (PVI) systems in patients with atrial fibrillation.

This single-center study included consecutive patients who underwent PVI using 1 of the 3 PFA systems: FARAWAVE (FARA) (n = 29), VARIPULSE (VARI) (n = 30), or PulseSelect (PSelect) (n = 32). Haptoglobin levels and myocardial injury biomarkers were evaluated at 3 time points: before the procedure (T1), immediately after the procedure (T2), and the next day after the procedure (T3).

PVI was performed using standard application counts for each system (median [interquartile range] FARA 34 [33-37], VARI 18 [17-20], and PSelect 48 [42-49]; P < .001). Haptoglobin levels (mg/dL) significantly decreased from baseline at T2 and T3 in all groups, with a more pronounced decline observed in the FARA group at T3 than in the PSelect (25 [16-50] vs. 60 [34-86]; P < .01). Lactate dehydrogenase levels increased significantly at T2 in the FARA and VARI groups, but not in the PSelect group. Other myocardial biomarkers (creatine kinase and aspartate aminotransferase) showed comparable increases across systems. No clinically significant renal impairment or acute kidney injury occurred in any of the groups.

Intravascular hemolysis is frequent yet generally subclinical after PFA. FARA exhibited higher hemolysis than PSelect, whereas VARI demonstrated an intermediate profile. Despite these differences, no clinically meaningful renal impairment was observed under standard application counts.