Comparison of HEMOlysis Markers Among Three Pulsed Field Ablation Systems: HEMO-PFA Study

Pulsed field ablation (PFA) has emerged as a novel non-thermal modality for atrial fibrillation (AF) ablation. While hemolysis is a known complication of PFA, comparative data among different systems remain limited.

We prospectively enrolled 150 consecutive AF patients undergoing ablation with one of three PFA systems: FARAPULSE (FP), PulseSelect (PS), or VARIPULSE (VP) (50 cases each). Perioperative blood samples were collected pre-procedure, immediately post-procedure, and at 24 h. Hemolysis markers (LDH, LD2, indirect bilirubin, haptoglobin) and myocardial injury markers (CK, CK-MB, troponin T) were measured. Procedural characteristics and complications were compared across the systems.

Among 144 analyzed patients, VP was associated with the shortest procedure time (76 ± 27 min vs. FP 91 ± 25 min and PS 97 ± 26 min, p < 0.001) and fewest applications (23 ± 5 vs. FP 40 ± 6 and PS 56 ± 26, p < 0.001). Hemolysis markers increased in all systems, but the magnitude varied. ΔLDH was highest with FP (95.1 ± 49.4 U/L), intermediate with PS (62.6 ± 38.1 U/L), and lowest with VP (41.3 ± 26.7 U/L; p < 0.001). Haptoglobin decreased most with FP (ΔHp -56.5 ± 27.2 mg/dL), followed by VP (-41.7 ± 25.8 mg/dL) and PS (-28.3 ± 21.6 mg/dL; p < 0.001). Myocardial injury also differed: ΔTroponin T was lowest with VP (1545 ± 920 pg/mL vs. FP 2392 ± 1123 pg/mL and PS 2128 ± 1041 pg/mL, p = 0.002), with a similar trend for ΔCK (141 ± 92 U/L vs. 231 ± 138 U/L and 207 ± 119 U/L, p < 0.001). Complications included acute kidney injury in two FP cases and cardiac tamponade in one PS case.

Hemolysis and myocardial injury differ among PFA systems. FP was associated with the greatest changes, PS with the least hemolysis, and VP with the least myocardial injury. These differences may reflect variations in pulse output, electrode configuration, and tissue contact visualization.