Hemolysis Induced by Pulsed‐Field Ablation of Atrial Arrhythmias: A Comparative Analysis of Current Systems

ABSTRACT Introduction Pulsed‐field ablation (PFA) is an emerging technology associated with dose‐dependent hemolysis as a recently recognized side effect. This study aimed to compare hemolysis levels and assess dose‐dependency across three PFA systems: a pentaspline catheter (PSC), a lattice‐tip focal catheter (LTFC), and a variable loop circular catheter (VLCC). Methods Patients treated for atrial arrhythmias with the LTFC ( n = 29) or the VLCC ( n = 30) were included from a prospective registry. A matched cohort of patients treated with the PSC ( n = 28) was recruited from the same registry. Creatinine levels and markers of hemolysis were measured pre‐ablation and 1 day postablation. Results Haptoglobin levels decreased significantly more with the PSC and VLCC compared to the LTFC (−0.65 [−0.76, −0.49] g/L; −0.56 [−0.78, −0.43] g/L, −0.21 [−0.32, −0.1] g/L, respectively; p < 0.001 for both). Per‐application decreases in haptoglobin also differed (−17.5 [−20.38, −13.58] mg/L, −24.35 [−36.36, −17.92] mg/L, −3.61 [−5.98, −2.13] mg/L, respectively; p < 0.001 for both). There was no significant difference in haptoglobin decrease between the PSC and VLCC per procedure ( p = 1.0). Haptoglobin decrease per application was significantly larger with the VLCC compared to the PSC ( p = 0.0048). Per procedure LDH increase followed a similar trend (49 [18, 81.25] U/L; 14 [6, 60] U/L; 13 [−4, 46] U/L; respectively; p = 0.037). No hemolysis‐related complications were observed. Conclusions Hemolysis levels vary significantly among PFA platforms. Focal PFA catheters induce less hemolysis per procedure and application compared to large‐footprint catheters.