Gold Christian, Pratz Paul, Falagkari Anastasia, Johnson Victoria, Post Florian, Roth Esther, Kupusovic Jana, Erath-Honold Julia W, Linz Dominik, Leistner David, Wakili Reza, Rottner Laura
Department of Cardiology and Vascular Medicine, University Heart and Vascular Center Frankfurt, Goethe University Frankfurt, Theodor-Stern Kai 7, Frankfurt am Main 60590, Germany.
Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Europace. 2025 Sep 1;27(9). doi: 10.1093/europace/euaf210.
The aim of this study was to assess the risk of haemolysis and the extent of myocardial and neural injury after monopolar, monophasic pulsed field ablation (PFA) using a lattice-tip catheter in comparison to single-shot PF ablation platforms employing bipolar, biphasic waveforms.
This prospective study included consecutive patients undergoing PFA for atrial fibrillation (AF) using the Affera™ mapping and ablation system (n = 40). Biomarkers for haemolysis (haptoglobin, lactate dehydrogenase, bilirubin), myocardial injury [high-sensitive troponin T, creatine kinase (CK), creatine kinase MB (CK-MB)], neurocardiac injury (S100), and renal function (creatinine) were assessed pre- and within 24 h post-ablation. A subgroup analysis of first-time pulmonary vein isolation-only procedures compared biomarker changes across Affera™, Farapulse™ (PFA-F), and PulseSelect™ (PFA-P). Post-procedural haemolysis occurred across all PFA platforms. The decrease in Δhaptoglobin was most pronounced in PFA-F [AfferaTM: (-) 13.8 ± 18.5 vs. PFA-P: (-) 36.8 ± 35.9 vs. PFA-F: (-) 60.7 ± 26.3 mg/dL, P = <0.001], without haemolysis-related complications. AfferaTM shows a trend towards a higher increase in myocardial injury markers (Δtroponin, 1537 [580] vs. 970 [1023] vs. 1051 [592] pg/mL, P = 0.180; ΔCK, 232 [168] vs. 153 [132] vs. 102 [144] U/L, P = 0.006; ΔCK-MB, 28.5 [15.3] vs. 14.6 [12.4] vs. 13.6 [10.5] U/L, P = 0.055, for Affera TM, PFA-P, and PFA-F, respectively). After ablation, S100 increased in PFA-P and PFA-F, but not in AfferaTM.
Post-procedural haemolysis after PFA for AF treatment is common and occurs across all PFA platforms. Pulsed field ablation using AfferaTM results in more myocardial injury than bipolar PFA systems with no indication of neural damage.
本研究旨在评估与采用双极、双相波形的单次脉冲场消融平台相比，使用点阵式电极导管进行单极、单相脉冲场消融（PFA）后溶血风险以及心肌和神经损伤程度。
这项前瞻性研究纳入了连续40例使用Affera™标测和消融系统接受房颤（AF）PFA治疗的患者。在消融前及消融后24小时内评估溶血生物标志物（触珠蛋白、乳酸脱氢酶、胆红素）、心肌损伤[高敏肌钙蛋白T、肌酸激酶（CK）、肌酸激酶同工酶MB（CK-MB）]、神经心脏损伤（S100）和肾功能（肌酐）。对仅首次进行肺静脉隔离术的亚组分析比较了Affera™、Farapulse™（PFA-F）和PulseSelect™（PFA-P）之间生物标志物的变化。所有PFA平台术后均发生溶血。PFA-F中触珠蛋白下降最为明显[AfferaTM：（-）13.8±18.5 vs. PFA-P：（-）36.8±35.9 vs. PFA-F：（-）60.7±26.3mg/dL，P =<0.001]，且无溶血相关并发症。AfferaTM显示心肌损伤标志物升高趋势更高（Δ肌钙蛋白，1537[580] vs. 970[1023] vs. 1051[592]pg/mL，P = 0.180；ΔCK，232[168] vs. 153[132] vs. 102[144]U/L，P = 0.006；ΔCK-MB，28.5[15.3] vs. 14.6[12.4] vs. 13.6[10.5]U/L，P = 0.055，分别对应AfferaTM、PFA-P和PFA-F）。消融后，PFA-P和PFA-F中S100升高，但AfferaTM中未升高。
房颤治疗PFA术后溶血常见，且发生于所有PFA平台。使用AfferaTM进行脉冲场消融导致的心肌损伤比双极PFA系统更严重，且无神经损伤迹象。
