Comparison of HEMOlysis Markers Among Three Pulsed Field Ablation Systems: HEMO-PFA Study

Background: Pulsed field ablation (PFA) has emerged as a novel non-thermal modality for atrial fibrillation (AF) ablation. While hemolysis is a known complication of PFA, comparative data among different systems remain limited. Methods: We prospectively enrolled 150 consecutive AF patients undergoing ablation with one of three PFA systems: FARAPULSE (FP), PulseSelect (PS), or VARIPULSE (VP) (50 cases each). Perioperative blood samples were collected pre-procedure, immediately post-procedure, and at 24 hours. Hemolysis markers (LDH, LD2, indirect bilirubin, haptoglobin) and myocardial injury markers (CK, CK-MB, troponin T) were measured. Procedural characteristics and complications were compared across the systems. Results: Six patients were excluded due to sampling-related hemolysis. VP was associated with the shortest procedure time (76 ± 27 min) and fewest applications (23 ± 5). Hemolysis markers increased significantly in all systems, with FP showing the greatest changes (ΔLDH 95.1 ± 49.4 U/L, ΔHp −56.5 ± 27.2 mg/dL). PS demonstrated the smallest reduction in haptoglobin, while VP exhibited the lowest myocardial injury (ΔCK 141 ± 92 U/L, ΔTroponin T 1545 ± 920 pg/mL). Complications included acute kidney injury in two FP cases and cardiac tamponade in one PS case. Conclusions: Hemolysis and myocardial injury differ among PFA systems. FP was associated with the greatest changes, PS with the least hemolysis, and VP with the least myocardial injury. These differences may reflect variations in pulse output, electrode configuration, and tissue contact visualization.