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

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Abstract
Aims: The aim of this study was to assess the risk of haemolysis and 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 and results: This prospective study included consecutive patients undergoing PFA for atrial fibrillation (AF) using the Affera™ mapping and ablation system (n = 40). Biomarkers for haemolysis (haptoglobin, lactate dehydrogenase, bilirubin), myocardial injury [high-sensitive troponin T, creatine kinase (CK), creatine kinase MB (CK-MB)], neurocardiac injury (S100), and renal function (creatinine) were assessed pre- and within 24 h post-ablation. A subgroup analysis of first-time pulmonary vein isolation-only procedures compared biomarker changes across Affera™, Farapulse™ (PFA-F), and PulseSelect™ (PFA-P). Post-procedural haemolysis occurred 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 haemolysis-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 Affera TM, PFA-P, and PFA-F, respectively). After ablation, S100 increased in PFA-P and PFA-F, but not in AfferaTM. Conclusion: Post-procedural haemolysis after PFA for AF treatment is common and occurs across all PFA platforms. Pulsed field ablation using AfferaTM results in more myocardial injury than bipolar PFA systems with no indication of neural damage.

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