Hemolysis and Renal Tubular Injury After Pulsed Field Ablation: A Comparison Between Two Commercially Available...

Area of Science:

• Cardiology
• Nephrology
• Medical Devices

Background:

• Pulsed field ablation (PFA) is known to cause intravascular hemolysis.
• The extent of hemolysis varies between different PFA platforms.
• The impact of platform-specific hemolysis on renal tubular injury remains unclear.

Purpose of the Study:

• To compare hemolysis markers and urinary tubular injury biomarkers between two PFA platforms.
• To assess short-term renal function following AF ablation using different PFA devices.
• To investigate if platform-dependent hemolysis differences influence renal outcomes.

Main Methods:

• Retrospective analysis of 131 patients undergoing AF ablation with either PulseSelect (n=72) or Farapulse (n=59) PFA platforms.
• Measurement of serum hemolysis markers (haptoglobin, LDH, T-Bil) and renal tubular injury biomarkers (NAG, β2-microglobulin, α1-microglobulin) pre- and post-ablation.
• Comparison of periprocedural changes in biomarkers between the two PFA platforms.

Main Results:

• Farapulse group showed significantly greater reductions in serum haptoglobin and increases in LDH and total bilirubin compared to PulseSelect.
• Despite increased hemolysis with Farapulse, changes in urinary tubular injury biomarkers (NAG, β2-microglobulin, α1-microglobulin) were comparable between platforms.
• Serum creatinine levels and short-term renal function did not differ significantly between the groups.

Conclusions:

• The Farapulse platform is associated with more pronounced intravascular hemolysis than the PulseSelect platform.
• Differences in hemolysis between PFA platforms did not result in detectable renal tubular injury in this study.
• Further research may be needed to fully elucidate long-term renal effects of PFA platform-specific hemolysis.