Quantification of hemolysis rates from pulsed field ablation: comparison of two technologies through in-silico modelling

Background Pulsed field ablation (PFA) has emerged as a promising technology for the treatment of atrial fibrillation. However, recent reports have linked PFA to cases of hemolysis-related complications, including renal failure. The mechanism behind this effect is attributed to pulsed electric fields, which generate a dose-dependent increase in transmembrane potential, leading to pore formation in red blood cells. While the susceptibility of erythrocytes to electroporation-induced hemolysis is well established, the impact of different cardiac PFA technologies on hemolysis remains underreported. Purpose To quantify hemolyzed blood volumes per pulse during PFA application using computational modeling for two types of ablation catheters: pentaspline catheter (PC) and lattice-tip focal catheter (FC). Methods A 3D computational PFA model was developed to determine the total volume of hemolyzed blood per pulse for two different technologies at voltages of 1 kV, 1.5 kV, and 2 kV. The hemolyzed volume was calculated as a function of the electric field intensity using previously published experimental data for 99% hemolysis percentage. Results Hemolysis levels showed a clear dependence on both the applied voltage and the type of catheter used. The PC produced a significantly greater volume of hemolyzed blood per pulse compared to the FC in all simulated scenarios. For the PC, the calculated volumes were 133.51 µL at 1 kV, 361.82 µL at 1.5 kV, and 638.36 µL at 2 kV. In contrast, the focal catheter generated considerably lower volumes: 6.54 µL, 47.66 µL, and 166.45 µL at the same voltages, respectively. The volumes obtained with the focal catheter were lower by approximately 95.1%, 86.8%, and 73.9%, respectively. Conclusions PFA-induced hemolysis increases in a dose-dependent manner with voltage and is more pronounced with catheters that have a higher number of electrodes (pentaspline) compared to focal catheters. Moreover, this effect can be quantified in silico, offering a useful approach to improve procedural safety.Hemolysis percentage