Hemolysis and renal tubular injury after pulsed field ablation: A comparison between two commercially available platforms

BACKGROUND Pulsed field ablation (PFA) causes intravascular hemolysis, and the degree of hemolysis differs between available platforms. Whether platform-dependent differences in hemolysis translate into differences in renal tubular injury has not been evaluated. OBJECTIVE To compare hemolysis markers, urinary tubular injury biomarkers, and short-term renal function between two commercially available PFA platforms in consecutive patients undergoing AF ablation. METHODS We retrospectively analyzed 131 consecutive patients treated with a circular multielectrode array platform (PulseSelect; n=72) or a pentaspline platform (Farapulse; n=59). Serum haptoglobin, hemoglobin, lactate dehydrogenase (LDH), total bilirubin (T-Bil), and creatinine, and urinary N-acetyl-β-D-glucosaminidase (NAG), β2-microglobulin, and α1-microglobulin were measured the day before and the day after ablation. Periprocedural changes were compared between platforms. RESULTS Serum haptoglobin decreased significantly after the procedure in both groups, with a greater decrease in the Farapulse group (ΔHaptoglobin: -59 [-71 to -33] vs. -36 [-51 to -24] mg/dL; P<0.001). Serum LDH and total bilirubin also increased more with Farapulse (P=0.002 and P=0.001). Despite the greater hemolytic response, changes in urinary NAG, β2-microglobulin, and α1-microglobulin did not differ significantly (all P>0.05), nor did serum creatinine (P=0.948). Device type was an independent predictor of ΔHaptoglobin and ΔT-Bil on multivariable regression but was not associated with any renal tubular biomarker. In patients with eGFR-defined CKD, platform-dependent hemolysis persisted but urinary tubular biomarker changes remained comparable. CONCLUSION Farapulse was associated with greater intravascular hemolysis than PulseSelect across multiple markers, but these differences did not translate into detectable renal tubular injury under the procedural conditions of this study.