Hemolysis, myocardial and neural injury after monopolar pulsed field ablation using a novel lattice-tip catheter to treat atrial fibrillation.

Background And Aims: Aim of this study was to assess the risk of hemolysis, the extent of myocardial and neural injury after monopolar, monophasic pulsed field ablation (PFA) using a lattice-tip catheter in comparison to single-shot PF ablation platforms employing bipolar, biphasic waveforms.

Methods: This prospective study included consecutive patients undergoing PFA for atrial fibrillation (AF) using the Affera™ mapping and ablation system (n=40). Biomarkers for hemolysis (haptoglobin, LDH, bilirubin), myocardial injury (high-sensitive troponin T, CK, CK-MB), neurocardiac injury (S100), and renal function (creatinine) were assessed pre- and within 24 hours post-ablation. A subgroup analysis of first-time PVI-only procedures compared biomarker changes across Affera™, Farapulse™ (PFA-F), and PulseSelect™ (PFA-P).

Results: Postprocedural hemolysis occured across all PFA platforms. The decrease in Δhaptoglobin was most pronounced in PFA-F (AfferaTM: (-) 13.8 ± 18.5 vs. PFA-P: (-) 36.8 ± 35.9 vs. PFA-F: (-) 60.7 ± 26.3 mg/dl, p=<0.001), without hemolysis-related complications. AfferaTM shows a trend towards a higher increase in myocardial injury markers (Δtroponin: 1537 [580] vs. 970 [1023] vs. 1051 [592] pg/ml, p=0.180; ΔCK: 232 [168] vs. 153 [132] vs. 102 [144] U/l, p=0.006; ΔCK-MB: 28.5 [15.3] vs. 14.6 [12.4] vs. 13.6 [10.5] U/l, p=0.055, for AfferaTM, PFA-P and PFA-F respectively). After ablation S100 increased in PFA-P and PFA-F, but not in AfferaTM.

Conclusion: Postprocedural hemolysis after PFA for AF treatment is common and occurs across all PFA platforms. PFA using AfferaTM results in more myocardial injury than bipolar PFA systems with no indication of neural damage.