Differential biomarker responses of hemolysis, inflammation, and myocardial injury after pulsed-field pulmonary vein isolation: balloon-in-basket versus circular catheter systems

Background Pulsed-field ablation (PFA) has emerged as a promising non-thermal energy source for pulmonary vein isolation (PVI) in atrial fibrillation (AF). However, data comparing the biological impact of novel PFA technologies remain limited. This study assessed changes in biomarkers of hemolysis, inflammation, and myocardial injury following PVI using two PFA systems: a balloon-in-basket (BiB) and a circular catheter (CC). Methods This prospective, single-center, non-randomized study enrolled consecutive patients undergoing first-time PVI. Biomarkers, including leukocytes, C-reactive protein (CRP), platelets, lactate dehydrogenase (LDH), haptoglobin, total bilirubin, troponin T, creatine kinase (CK), myoglobin, creatinine, and estimated glomerular filtration rate (eGFR), were measured before and 16–18 hours after ablation. Results Forty patients were included (BiB n=20, CC n=20). Baseline characteristics were comparable. Acute PVI was achieved in all cases. BiB required fewer applications (16 vs. 32, p < 0.001) but more contrast (45 vs. 30 mL, p < 0.001) and had longer procedure and left atrial dwell times (p < 0.001). No complications occurred. Both systems caused significant increases in leukocytes, CRP, LDH, troponin, and CK without inter-group differences. Haptoglobin decreased significantly in both, more pronounced with CC (Δ –13 vs. –4 mg/dL, p = 0.090). Renal function remained stable overall, with one patient in the CC group developing a transient acute kidney injury. In the BiB group, Δ-hemoglobin correlated inversely with the number of applications (p = 0.046). In the CC group, Δ-troponin and Δ-CK correlated positively with the number of applications (p < 0.05). Conclusion Despite comparable overall biomarker responses between the two PFA systems, the more pronounced haptoglobin decline and the isolated occurrence of transient AKI in the CC group suggests possible differences in biological tissue interaction, warranting further investigation in larger studies.Comparison of delta values.