Hemolysis related to PFA: multicenter comparative study of next generation nanosecond with conventional PFA systems
M Marino, E Chiarazzo, V M La Fazia, C Gianni, S Mohanty, G Stifano, W Bode, K Awad, D Burkardt, J Gallinghouse, R Horton, A Al-Ahmad, L Di Biase, A NataleAbstract
Background
Hemolysis is a well-recognized consequence of microseconds pulsed field ablation (PFA), however its occurrence with nanoseconds PFA have not been determined.
Purpose
the aim of the study is to compare hemolysis profiles across different PFA systems.
Methods
Consecutively patients with AF undergoing first-time PFA ablation with nanosecond, pentaspline, and lattice-tip catheters were included in this prospective analysis. Hemolysis was assessed by haptoglobin (Hp), lactate dehydrogenase, and bilirubin measured before (T1) and after (T2) ablation. Hemolysis was defined as a >10 mg/dL decrease in Hp between T1 and T2. Significant hemolysis was defined as Hp ≤25 mg/dL.
Results
94 (63% male, mean age 58.9 ± 1.73) patients were included. No significant baseline and procedural caractheristic was found between the 3 system. The catheters used were nanoseconds, pentaspline and lattice-tip in 30 (32%), 34 (36%) and 34 (32%) respectively. Hemolysis occurred in 88 (91.5%) of patients. Significant hemolysis was observed in 21 (70%) nanosecond, 27 (79.4%) pentaspline and 7 (23%) lattice-tip cases (p<0.001). Univariable and multivariable analysis showed that nanoseconds and pentaspline catheters were associated with a similarly high risk of significant hemolysis compared with lattice-tip catheter (p<0.001). No significant difference was observed between nanoseconds and pentaspline catheter. Hp decrease per application was greater with nanoseconds (1.93 ± 2.87 mg/dL, p = 0.52) and pentaspline (0.73 ± 0.43 mg/dL, p = 0.11) than with lattice-tip (0.04 ± 0.05 mg/dL, p = 0.43). catheter.
Conclusions
Hemolysis commonly occurs across PFA procedures, irrespective of pulse duration, and is greater with single-shot than focal system.