Characterization and Clinical Significance of Hemolysis After Pulsed Field Ablation for Atrial Fibrillation: Results of a Multicenter Analysis.

IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-10-01 Epub Date: 2024-08-30 DOI:10.1161/CIRCEP.124.012732
Miruna A Popa, Sandrine Venier, Roberto Menè, Domenico Giovanni Della Rocca, Frédéric Sacher, Nicolas Derval, Mélèze Hocini, Stéphanie Dulucq, Guido Caluori, Stéphane Combes, Jean-Paul Albenque, Federica Saitta, Bernhard Haller, Gian-Battista Chierchia, Carlo de Asmundis, Pascal Defaye, Serge Boveda, Pierre Jaïs
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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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 (P<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 P<0.001). Hemolysis correlated with the number of PFA deliveries (r=0.62 [95% CI, 0.33-0.80]; P<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; P=0.010).

Conclusions: 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.

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脉冲场消融治疗心房颤动后溶血的特征和临床意义:多中心分析结果。
背景:脉冲场消融术(PFA)越来越多地应用于治疗心房颤动的临床实践中。虽然红细胞对电穿孔的易感性已得到公认,但心脏 PFA 技术对溶血的影响仍未得到充分报道。本研究旨在调查 PFA 诱导溶血的发生率、严重程度和临床影响:我们纳入了在欧洲 4 个高容量中心接受心房颤动导管消融术的 145 名患者和接受射频消融术(40-90 W)的 70 名患者。病变集包括阵发性心房颤动的肺静脉隔离术和持续性心房颤动的肺静脉隔离术(附加病变)。对基线、消融结束时和术后24小时的血液样本进行了溶血和肾功能生物标志物分析:各组的基线特征非常均衡(总平均年龄为 65.7±9.4 岁;69.3% 为男性)。消融手术的平均PFA分娩次数为61.6±27.4次,射频持续时间为26.3±15.0分钟。PFA与射频消融术后,94.3%的患者与6.8%的患者检测到溶血(PPP50 mL/min (Δcrea, 27.0±103.1 versus -0.2±12.1 µmol/L; P=0.010):结论:血管内溶血是PFA术后的常见现象,并随着PFA分娩次数的增加而增加。在完全阐明 PFA 相关溶血的临床影响之前,有必要在消融术中谨慎调整 PFA 输送量。
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来源期刊
CiteScore
13.70
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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