Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux (M.A.P., F. Sacher, N.D., M.H., P.J.).
IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université and INSERM-U1045, University of Bordeaux, France (M.A.P., F. Sacher, N.D., M.H., G.C., P.J.).
Circ Arrhythm Electrophysiol. 2024 Oct;17(10):e012732. doi: 10.1161/CIRCEP.124.012732. Epub 2024 Aug 30.
Pulsed field ablation (PFA) is increasingly used in clinical practice for the treatment of atrial fibrillation. While the susceptibility of erythrocytes to electroporation is well established, the effect of cardiac PFA technologies on hemolysis has remained underreported. The aim of this study was to investigate the incidence, severity, and clinical impact of PFA-induced hemolysis.
We included n=145 patients undergoing atrial fibrillation catheter ablation with a pentaspline PFA catheter (biphasic, bipolar pulses of 2 kV) and n=70 patients receiving radiofrequency ablation (40-90 W) at 4 high-volume European centers. The lesion set comprised pulmonary vein isolation for paroxysmal atrial fibrillation and pulmonary vein isolation±additional lesions for persistent atrial fibrillation. Hemolysis and renal function biomarkers were analyzed in blood samples at baseline, at the end of ablation, and 24 hours after the procedure.
Baseline characteristics were well balanced between groups (overall mean 65.7±9.4 years; 69.3% men). The ablation procedures comprised a mean of 61.6±27.4 PFA deliveries and 26.3±15.0 minutes RF duration. Hemolysis was detected in 94.3% versus 6.8% of patients after PFA versus radiofrequency ablation (<0.001): PFA was associated with significantly lower haptoglobin levels (0.5±0.4 versus 1.0±0.4 g/L), while free plasma hemoglobin (592.8±330.6 versus 147.8±183.0 mg/L), bilirubin (21.3±11.3 versus 14.8±8.8 µmol/L), and LDH (lactate dehydrogenase, 352.7±115.7 versus 253.2±56.5 U/L) were significantly higher after PFA compared with radiofrequency ablation (all <0.001). Hemolysis correlated with the number of PFA deliveries (r=0.62 [95% CI, 0.33-0.80]; <0.001), with the highest severity occurring ≥54 PFA deliveries. After PFA, hemoglobinuria occurred in 36.4%, while creatinine increase was higher in patients with baseline glomerular filtration rate <50 mL/min than with baseline glomerular filtration rate >50 mL/min (Δcrea, 27.0±103.1 versus -0.2±12.1 µmol/L; =0.010).
Intravascular hemolysis is a frequent finding after PFA and increases with the number of PFA deliveries. Until the clinical impact of PFA-associated hemolysis is fully elucidated, a careful titration of PFA deliveries during the ablation procedure is warranted.
脉冲场消融（PFA）越来越多地用于治疗房颤的临床实践。虽然红细胞对电穿孔的敏感性已得到充分证实，但心脏 PFA 技术对溶血的影响仍报道较少。本研究旨在研究 PFA 诱导的溶血的发生率、严重程度和临床影响。
我们纳入了 145 名在欧洲 4 个高容量中心接受房颤导管消融的患者，他们使用 pentaspline PFA 导管（双相，2 kV 的双极脉冲），70 名接受射频消融（40-90 W）的患者。消融程序包括阵发性房颤的肺静脉隔离和持续性房颤的肺静脉隔离±附加消融。在基线、消融结束时和手术后 24 小时，在血液样本中分析溶血和肾功能生物标志物。
两组患者的基线特征平衡良好（总体平均年龄 65.7±9.4 岁；69.3%为男性）。消融程序包括平均 61.6±27.4 次 PFA 输送和 26.3±15.0 分钟的射频持续时间。PFA 组 94.3%的患者与射频消融组 6.8%的患者发生溶血（<0.001）：PFA 组与射频消融组相比，血红蛋白水平显著降低（0.5±0.4 与 1.0±0.4 g/L），游离血浆血红蛋白（592.8±330.6 与 147.8±183.0 mg/L）、胆红素（21.3±11.3 与 14.8±8.8 µmol/L）和乳酸脱氢酶（LDH，352.7±115.7 与 253.2±56.5 U/L）明显升高（均<0.001）。溶血与 PFA 输送次数相关（r=0.62[95%CI，0.33-0.80]；<0.001），输送次数最高时严重程度最高≥54 次。PFA 后 36.4%的患者出现血红蛋白尿，而肾小球滤过率基线<50 mL/min 的患者与肾小球滤过率基线>50 mL/min 的患者相比，肌酐升高更高（Δcrea，27.0±103.1 与-0.2±12.1 µmol/L；=0.010）。
PFA 后血管内溶血是常见现象，并且随着 PFA 输送次数的增加而增加。在充分阐明 PFA 相关溶血的临床影响之前，有必要在消融过程中仔细调整 PFA 输送次数。
