He Jialing, Li Ke, He Chunrong, Zhang Ling, Yang Du, Qin Haitao, Xu Junbo, Cai Lin, Luo Duan, Yang Guoshu, Xiong Shiqiang, Luo Yan, Sun Huaxin, Xiong Tianhua, Li Bolin, Xu Bao, He Guijun, Yang Yongxin, Zhang Zhen, Liu Hanxiong
Department of Cardiology, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Cardiovascular Disease Research Institute of Chengdu, Sichuan, P.R. China.
Department of Clinical Laboratory, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, P.R. China.
Heart Rhythm. 2025 Jul 29. doi: 10.1016/j.hrthm.2025.07.042.
Pulsed field ablation (PFA) is an innovative energy modality for cardiac ablation, but has been increasingly associated with hemolysis. While existing research primarily focuses on basket or flower-shaped catheters, data on circular PFA catheters remain limited.
The objective of this study was to evaluate the effects of dose and contact of a circular PFA catheter on hemolysis and renal function in a porcine model.
In vitro experiments compared suspended and myocardial contact PFA delivery and radiofrequency ablation (RFA). Blood samples were analyzed for free hemoglobin (fHb), haptoglobin, and serum potassium. In vivo, 5 pigs underwent RFA and PFA (100-400 applications) in the right heart, with blood samples collected from immediate post-procedure to 20 days.
Myocardial contact PFA delivery reduced hemolysis compared to suspended PFA delivery. PFA caused dose-dependent hemolysis, with fHb peaking immediately post-procedure and recovering within 24 hours, along with haptoglobin and indirect bilirubin. Hemoglobin transiently decreased (24-72 hours) but normalized by day 5. Serum creatinine remained stable, showing no acute renal injury even after 400 PFA applications.
PFA-induced hemolysis demonstrates dose-dependency and is exacerbated by inadequate tissue contact, yet resolves spontaneously without inducing acute kidney injury. These findings support the safety of circular PFA catheters but highlight the need for further studies in larger cohorts and human subjects for clinical validation.
脉冲场消融（PFA）是一种用于心脏消融的创新能量模式，但与溶血的关联日益增加。虽然现有研究主要集中在篮状或花形导管，但关于圆形PFA导管的数据仍然有限。
本研究的目的是在猪模型中评估圆形PFA导管的剂量和接触对溶血及肾功能的影响。
体外实验比较了悬浮式和心肌接触式PFA输送以及射频消融（RFA）。分析血样中的游离血红蛋白（fHb）、触珠蛋白和血清钾。在体内，5头猪在右心接受RFA和PFA（100 - 400次应用），从术后即刻至20天采集血样。
与悬浮式PFA输送相比，心肌接触式PFA输送减少了溶血。PFA导致剂量依赖性溶血，fHb在术后即刻达到峰值并在24小时内恢复，同时触珠蛋白和间接胆红素也如此。血红蛋白短暂下降（24 - 72小时）但在第5天恢复正常。血清肌酐保持稳定，即使在400次PFA应用后也未显示急性肾损伤。
PFA诱导的溶血表现出剂量依赖性，并且因组织接触不足而加剧，但可自发缓解而不诱发急性肾损伤。这些发现支持圆形PFA导管的安全性，但强调需要在更大队列和人类受试者中进行进一步研究以进行临床验证。
