ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025
Biochemical evidence and clinical significance of hemolysis following catheter ablation with a lattice-tip PFA catheter.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntravascular hemolysis(IH) is an inherent limitation of pulsed field ablation(PFA) technology. The severity of IH is multifactorial and differs between PFA systems. This study aimed to assess the biochemical evidence and clinical significance of IH induced by a lattice-tip PFA catheter.
methodsPatients with atrial fibrillation(AF) undergoing catheter ablation with a lattice-tip PFA catheter or with radiofrequency (RF) (50/90 W) were eligible. Changes in haptoglobin, hemoglobin(Hb), lactate dehydrogenase(LDH), indirect bilirubin, and creatinine were assessed in blood samples collected at baseline (T0), immediately (T1), and 24-h (T2) post-ablation. Clinically relevant IH was defined as changes in biochemical markers of hemolysis in combination with a hemoglobin drop ≥ 2 g/dL or renal biomarker changes fulfilling criteria for AKI. Furthermore, in order to properly interpret the observed changes in haptoglobin, "biochemical events" previously associated with direct markers of IH were analyzed [(T2 haptoglobin ≤ 0.25 g/l, T2/T0 haptoglobin ratio < 0.85, and T2-T0 haptoglobin difference < Q1 (-0.1 g/l)].
resultsA total of 142 patients [102/142 (72%) in PFA group; 40/142 (28%) in RF group] were included, with comparable characteristics. Significant changes in Hb and LDH were found in both groups. The PFA group experienced a greater decrease in haptoglobin levels compared to RF (MD = -0.02 g/L, 95% CI [-0.04, 0]; p = 0.043), while "biochemical events" were infrequent and similar between groups. None of the participants fulfilled the definition of clinically relevant IH. In the PFA group, the number of lesions was marginally associated with greater biomarker changes.
conclusionsIn this observational real-world cohort, the lattice-tip PFA catheter was associated with statistically significant, yet relatively small reductions of haptoglobin post-procedurally compared to RF, with no case of clinically relevant IH being reported.
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