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Arrhythmias & electrophysiologyCohort study

Thromboinflammation and hemolysis after pulsed field ablation with a pentaspline catheter: Clinical predictors, renal safety, and rhythm outcomes

Heart RhythmPublished

  • prospective
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Authors' conclusion

PFA is associated with a similar thromboinflammatory reaction as RFA. PFA-induced hemolysis occurs in all patients and is significantly associated with renal function decline, inflammation, and platelet activation even with limited PFA deliveries. Females are at a higher risk of significant hemolysis after PFA.

Study context

Population
Patients with paroxysmal atrial fibrillation receiving pulmonary vein isolationPulsed field ablation (PFA) 30 · radiofrequency ablation (RFA) 30
Participants
60 patients
Exposure
PFA vs RFA
  • PFAn = 30
  • RFAn = 30

Main finding

As reported in the abstract

Intravascular hemolysis

PFA

100%

mean deliveries
42.8 ± 3.7

Observational data: associations, not effects.

Further findings

Independent predictor of significant hemolysis after PFA: female sex

Comparisonodds ratio (95% CI)P value
Female sex · only independent predictor7.8 (1.2–50.2)P = 0.031

Early recurrences

Late recurrences

OutcomePFARFAEstimateP value
Leukocyte releaseΔ3.0 ± 2.3 × 109/L3.6 ± 2.3 × 109/LP = 0.254
Nitric oxide levels−26.5% ± 17.8%Not reported in the abstract
Nitric oxide levels — decreased significantly in the PFA group only
P < .001
  • Early recurrences: all P > .05
  • Late recurrences: all P > .05

Acute platelet activation and endothelial cell damage biomarker changes

Similar between PFA and RFA

Hemolysis burden association with creatinine increase, inflammation, and platelet activation

No acute kidney injury occurred; hemolysis burden significantly associated with creatinine increase, inflammation, and platelet activation

Safety

In-hospital pericarditis · lower with PFA

P = 0.028

Original publication

Thromboinflammation and hemolysis after pulsed field ablation with a pentaspline catheter: Clinical predictors, renal safety, and rhythm outcomes. Heart Rhythm. Published 17 January 2026. doi:10.1016/j.hrthm.2026.01.018
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Summarised from the published abstract; every number is checked against it