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; VOLT™, Abbott) and a circular catheter (PS; PulseSelect™, Medtronic). 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 16-18h after ablation. Results: Forty patients were included (BiB n=20, PS n=20). Patients treated with PS were older (73 vs. 63, p=0.016) and had higher incidence of persistent AF (80% vs. 30%, p = 0.001). Acute PVI was achieved in all cases. BiB required fewer applications (13.5 vs. 32, p<0.001) but a higher contrast agent volume (40 vs. 30 mL, p<0.001). Both systems resulted in significant increases in leukocytes, CRP, troponin, and CK without inter-group differences. Haptoglobin decreased significantly with PS but remained stable with BiB (Δ –0.13 vs. +0.035 g/L, p<0.001), while LDH increased similarly in both groups. Renal function remained stable. In BiB group, ΔLDH correlated with application number (p < 0.001). In PS group, Δtroponin and ΔCK correlated with application number (p < 0.05). Conclusion: Despite comparable overall biomarker responses between the two PFA systems, the distinct haptoglobin patterns highlight possible differences in biological tissue interaction, warranting further investigation in larger studies.