Balloon vs. balloon-comparison of hemolysis and renal markers after cryoballoon vs. ballon-in-basket pulsed field pulmonary vein isolation.

Abstract

Background and aims: Single-shot ablation systems are widely used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Cryoballoon ablation (CBA) ablation is a well-established thermal method, while balloon-in-basket pulsed field ablation (BiB-PFA) represents a novel non-thermal modality. Both may elicit systemic effects, including hemolysis and renal stress. This study aimed to compare biomarker changes indicative of hemolysis and renal function following CBA vs. BiB-PFA.

Methods: In this prospective, non-randomized, single-center study, patients undergoing first-time PVI with either CBA or BiB-PFA were enrolled. Venous blood samples were collected before PVI and at day 1 post procedure. Laboratory analyses included lactate dehydrogenase (LDH), haptoglobin, hemoglobin, myoglobin, total bilirubin, creatinine, and estimated glomerular filtration rate (eGFR).

Results: A total of 100 patients were included (CBA: n = 50; BiB-PFA: n = 50). Acute and first-pass PVI was achieved in all cases. CBA resulted in a significantly greater increase in LDH (Δ+60 vs. + 47 U/L; p = 0.038) and a more pronounced decline in haptoglobin (Δ-13 vs. -3 mg/dl; p = 0.003). Hemoglobin decreased after BiB-PFA (Δ-0.62 g/dl) but slightly increased after CBA (Δ+0.18 g/dl; p < 0.001). Myoglobin and bilirubin changes were comparable. There was no significant difference in kidney function change between the groups (CBA: Δ-2.0 vs. BiB-PFA: glomerular filtration rate -1.0 ml/min; p = 0.522).

Conclusion: While CBA was associated with more pronounced hematologic changes, kidney function did not differ between groups. These findings emphasize the systemic effects of catheter design and energy modality while supporting the renal safety of both techniques.