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Hemolysis After Pulsed Field Ablation With a Variable-Loop Irrigated Circular Catheter.

Iwanari Kawamura1, Shinsuke Miyazaki1, Ryosuke Kato1

  • 1Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.

Pacing and Clinical Electrophysiology : PACE
|March 17, 2026
PubMed
Summary

Pulsed field ablation (PFA) using a variable-loop irrigated circular catheter (VLCC) can cause hemolysis, indicated by increased plasma-free hemoglobin. Further research is needed to assess the safety of different PFA systems.

Keywords:
catheter ablationcomplicationelectroporationhemolysispulsed electrical field

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Hemolysis is a known complication of pulsed field ablation (PFA).
  • Existing data on PFA-induced hemolysis primarily uses the Pentaspline catheter.
  • Limited information exists on hemolysis associated with other PFA systems.

Purpose of the Study:

  • To evaluate hemolysis in patients undergoing PFA with a variable-loop irrigated circular catheter (VLCC).
  • To assess the safety and biophysical effects of VLCC-based PFA.

Main Methods:

  • Seven patients with paroxysmal atrial fibrillation underwent PFA using a VLCC and TRUPULSE generator.
  • Procedures included pulmonary vein and posterior wall isolation guided by a tissue proximity indicator.
  • Plasma-free hemoglobin, bilirubin, lactate dehydrogenase, creatine kinase, and haptoglobin levels were measured pre- and post-procedure.

Main Results:

  • Significant increase in plasma-free hemoglobin from 0.01 to 0.05 g/dL post-procedure (p < 0.001).
  • Elevated bilirubin and lactate dehydrogenase, with subnormal haptoglobin in 50% of patients.
  • Significant increase in creatine kinase (p = 0.018); no acute kidney injury observed.

Conclusions:

  • This is the first study to assess hemolysis with VLCC-based PFA using plasma-free hemoglobin.
  • Findings highlight the need for individual evaluation of PFA systems for safety and biophysical effects.