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Hemolysis and renal tubular injury after pulsed field ablation: A comparison between two commercially available
Keisuke Miyajima1, Kazuku Ishihara1, Takeru Yamada1
1Department of Cardiology, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan.
Background:
Pulsed field ablation (PFA) causes intravascular hemolysis, and the degree of hemolysis differs between available platforms. Whether platform-dependent differences in hemolysis translate into differences in renal tubular injury has not been evaluated.
Objective:
To compare hemolysis markers, urinary tubular injury biomarkers, and short-term renal function between 2 commercially available PFA platforms in consecutive patients undergoing AF ablation.
Methods:
We retrospectively analyzed 131 consecutive patients treated with a circular multielectrode array platform (PulseSelect; n = 72) or a pentaspline platform (Farapulse; n = 59). Serum haptoglobin, hemoglobin, lactate dehydrogenase, total bilirubin, and creatinine, and urinary N-acetyl-β-D-glucosaminidase (NAG), β2-microglobulin, and α1-microglobulin were measured the day before and the day after ablation. Periprocedural changes were compared between platforms.
Results:
Serum haptoglobin decreased significantly after the procedure in both groups, with a greater decrease in the Farapulse group (ΔHaptoglobin: -59 [-71 to -33] vs -36 [-51 to -24] mg/dL; P < .001). Serum lactate dehydrogenase and total bilirubin also increased more with Farapulse (P = .002 and P = .001). Despite the greater hemolytic response, changes in urinary N-acetyl-β-D-glucosaminidase, β2-microglobulin, and α1-microglobulin did not differ significantly (all P > .05), nor did serum creatinine (P = .948). Device type was an independent predictor of ΔHaptoglobin and Δtotal bilirubin on multivariable regression but was not associated with any renal tubular biomarker. In patients with eGFR-defined chronic kidney disease, platform-dependent hemolysis persisted, but urinary tubular biomarker changes remained comparable.
Conclusion:
Farapulse was associated with greater intravascular hemolysis than PulseSelect across multiple markers, but these differences did not translate into detectable renal tubular injury under the procedural conditions of this study.
