Balloon-in-basket PFA: strong on the veins, gentle on the blood - inflammatory, hemolytic and myocardial biomarker response

Background Pulsed field ablation (PFA) using the balloon-in-basket (BiB)-PFA system enables rapid, tissue-selective pulmonary vein isolation (PVI). However, the biological effects on hemolysis, inflammation, and myocardial injury remain poorly defined. Purpose To characterize inflammatory, hemolytic, and myocardial biomarker changes following BiB-PFA PVI. Methods In this prospective, single-center study, patients undergoing first-time BiB-PFA PVI were analyzed. Venous blood samples were collected before and 18-24 hours after ablation. Biomarkers included leukocytes, platelets, hemoglobin, C-reactive protein (CRP), haptoglobin, bilirubin, lactate dehydrogenase (LDH), creatinine, estimated glomerular filtration rate (GFR), myoglobin, creatine kinase (CK), and troponin T. Correlations between biomarker changes and the number of PFA applications were assessed. Results A total of 55 patients were included (median age 65 [58–72] years, 45% female, 55% paroxysmal AF). All achieved acute PVI without major adverse events. Median Δ-values [IQR] were: Δ leukocytes +1.2 [–0.3; 3.1] ×109/L, Δ CRP +3.2 [0.8; 5.7] mg/L, Δ hemoglobin –0.7 [–1.2; 0.1] g/dL, Δ bilirubin +2.5 [0.7; 7.2] µmol/L, Δ LDH +56 [31.5; 71.5] U/L, Δ CK +210 [126; 319] U/L, and Δ troponin T +1087 [706; 1493] ng/L (all p<0.001). Only LDH correlated with the number of applications (r=0.32, p=0.037). Other biomarkers were independent of ablation extent. Conclusion BiB-PFA PVI induces mild systemic inflammation, minimal hemolysis, and myocardial biomarker release without clinical adverse events. The dose-dependent LDH increase indicates a limited hemolytic component, while other biomarker responses remain unaffected by number of applications, supporting the biological safety of BiB-PFA PVI.