Hemolysis after pulsed-field ablation for atrial fibrillation: Characterization and clinical significance

Miruna-Andreea Popa (Pessac)1, M. Arnaud (Pessac)1, S. Buliard (Pessac)1, B. Bouyer (Pessac)1, G. Caluori (Pessac)1, K. Vlachos (Pessac)1, K. Benali (Pessac)1, M. Yokoyama (Pessac)1, C. Kowalewski (Pessac)1, C. Monaco (Pessac)1, J. Duchateau (Pessac)1, R. Tixier (Pessac)1, T. Pambrun (Pessac)1, N. Derval (Pessac)1, F. Sacher (Pessac)1, M. Hocini (Pessac)1, M. Haïssaguerre (Pessac)1, P. Jaïs (Pessac)1

1Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux Department of Cardiac Pacing and Electrophysiology Pessac, Frankreich



Pulsed-field ablation is a novel non-thermal ablation modality which has been recently introduced in clinical practice for the treatment of atrial fibrillation (AF). While the susceptibility of erythrocytes to electroporation is well-established, the effect of cardiac PFA technologies on erythrocyte destruction has not been described so far. The aim of this study was to investigate whether PFA induces clinically significant hemolysis.


We prospectively included 55 consecutive patients with paroxysmal or persistent AF who received catheter ablation with either PFA (n=31) or conventional radiofrequency ablation (RFA, n=24). PFA was performed using a pentaspline catheter (biphasic, bipolar pulses) and RFA with a 3.5 mm irrigated-tip catheter (40-45 W/20 s). The lesion set comprised pulmonary vein isolation (PVI) for paroxysmal AF and PVI + additional lines for persistent AF. Established biomarkers of hemolysis and kidney function were analyzed in blood samples obtained at the end of ablation and 24 hours after the procedure.


Baseline characteristics were well-balanced between groups (age 66.3 ± 8.6 years, male 69.1%, persistent AF 49.1%, p>0.05). Acutely after ablation, hemolysis was detected in plasma samples of 28/31 (90.3%) patients treated with PFA vs. 4/24 (16.7%) patients treated with RFA (p<0.001). Free plasma hemoglobin was significantly higher in PFA (611.2 ± 342.2 mg/dl) than in RFA (205.6 ± 232.3 mg/dl, p<0.001). PFA was associated with a decrease in haptoglobin levels by 36.7% (0.54 ± 0.33 vs. 0.89 ± 0.33 g/l) and an increase in bilirubin levels by 38.6% (18.31 ± 8.84 vs. 12.97 ± 4.36 µmol/l) 24 hours after the procedure (both p<0.001). No significant changes in creatinine levels and glomerular filtration rate were observed in either group (p>0.05). Acute kidney injury was detected in 2/31 (6.5%) vs. 2/24 (8.3%) patients in the PFA vs. RFA group (p=0.927). A strong positive correlation between free plasma hemoglobin levels and the number of PFA deliveries was observed (Pearson r = 0.678, p<0.001).


Hemolysis is a very frequent finding after PFA for AF and correlates with the number of PFA deliveries. Future large-scale investigations are warranted to assess the impact of PFA-induced hemolysis on renal function.

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