Comparative analysis of hemolysis incidence across 3 different pulsed field ablation systems

Background Pulsed field ablation (PFA) is associated with a risk of hemolysis; however, the differences among 3 single-shot PFA systems remain unclear. Objective This study aimed to examine the differences in hemolysis among 3 PFA systems. Methods We assessed changes in hemolytic, myocardial, and renal biomarkers at baseline and 24 hours after ablation in 131 patients with atrial fibrillation treated with 3 PFA systems (VARIPULSE, n = 26; PulseSelect, n = 62; FARAPULSE, n = 43), as well as in 23 patients undergoing radiofrequency ablation (control) and 8 patients without ablation (nonablation control). Results Baseline characteristics were comparable across the groups. Haptoglobin levels decreased from 97.3 ± 52.1 to 49.9 ± 40.1 in the VARIPULSE group, 96.7 ± 41.9 to 53.5 ± 31.2 in the PulseSelect group, and 90.6 ± 43.8 to 27.3 ± 18.6 in the FARAPULSE group (all P < .001). Compared with the control group, both hemolysis and myocardial injury were more pronounced in the PFA groups, with the greatest severity observed in the FARAPULSE group. No significant deterioration in renal function was observed in any group after ablation; however, 2 cases of stage 1 acute kidney injury occurred in the FARAPULSE group, both of which fully resolved with hydration. Postablation haptoglobin levels exhibited a significant negative correlation with the number of applications across all PFA groups. Multivariate regression analysis identified the application ratio (total number of applications/manufacturer’s recommended applications) and body mass index as independent predictors of reduced haptoglobin levels. Conclusion Intravascular hemolysis is a pertinent concern after PFA and is associated with the number of applications and body mass index, with potential differences across the 3 PFA systems.