Ourania Kariki, Konstantinos Pamporis, Athanasios Saplaouras, Panagiotis Mililis, Theodoros Efremidis, Antonios Martinos, Stavroula Koskina, Anna Kostopoulou, George Poulos, Stylianos Dragasis, Eleni Nikoli, Konstantinos P Letsas, Michael Efremidis
{"title":"格尖PFA导管消融后溶血的生化证据及临床意义。","authors":"Ourania Kariki, Konstantinos Pamporis, Athanasios Saplaouras, Panagiotis Mililis, Theodoros Efremidis, Antonios Martinos, Stavroula Koskina, Anna Kostopoulou, George Poulos, Stylianos Dragasis, Eleni Nikoli, Konstantinos P Letsas, Michael Efremidis","doi":"10.1007/s10840-025-02163-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intravascular hemolysis(IH) is an inherent limitation of pulsed field ablation(PFA) technology. The severity of IH is multifactorial and differs between PFA systems. This study aimed to assess the biochemical evidence and clinical significance of IH induced by a lattice-tip PFA catheter.</p><p><strong>Methods: </strong>Patients with atrial fibrillation(AF) undergoing catheter ablation with a lattice-tip PFA catheter or with radiofrequency (RF) (50/90 W) were eligible. Changes in haptoglobin, hemoglobin(Hb), lactate dehydrogenase(LDH), indirect bilirubin, and creatinine were assessed in blood samples collected at baseline (T0), immediately (T1), and 24-h (T2) post-ablation. Clinically relevant IH was defined as changes in biochemical markers of hemolysis in combination with a hemoglobin drop ≥ 2 g/dL or renal biomarker changes fulfilling criteria for AKI. Furthermore, in order to properly interpret the observed changes in haptoglobin, \"biochemical events\" previously associated with direct markers of IH were analyzed [(T2 haptoglobin ≤ 0.25 g/l, T2/T0 haptoglobin ratio < 0.85, and T2-T0 haptoglobin difference < Q1 (-0.1 g/l)].</p><p><strong>Results: </strong>A total of 142 patients [102/142 (72%) in PFA group; 40/142 (28%) in RF group] were included, with comparable characteristics. Significant changes in Hb and LDH were found in both groups. The PFA group experienced a greater decrease in haptoglobin levels compared to RF (MD = -0.02 g/L, 95% CI [-0.04, 0]; p = 0.043), while \"biochemical events\" were infrequent and similar between groups. None of the participants fulfilled the definition of clinically relevant IH. In the PFA group, the number of lesions was marginally associated with greater biomarker changes.</p><p><strong>Conclusions: </strong>In this observational real-world cohort, the lattice-tip PFA catheter was associated with statistically significant, yet relatively small reductions of haptoglobin post-procedurally compared to RF, with no case of clinically relevant IH being reported.</p>","PeriodicalId":520675,"journal":{"name":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Biochemical evidence and clinical significance of hemolysis following catheter ablation with a lattice-tip PFA catheter.\",\"authors\":\"Ourania Kariki, Konstantinos Pamporis, Athanasios Saplaouras, Panagiotis Mililis, Theodoros Efremidis, Antonios Martinos, Stavroula Koskina, Anna Kostopoulou, George Poulos, Stylianos Dragasis, Eleni Nikoli, Konstantinos P Letsas, Michael Efremidis\",\"doi\":\"10.1007/s10840-025-02163-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intravascular hemolysis(IH) is an inherent limitation of pulsed field ablation(PFA) technology. The severity of IH is multifactorial and differs between PFA systems. This study aimed to assess the biochemical evidence and clinical significance of IH induced by a lattice-tip PFA catheter.</p><p><strong>Methods: </strong>Patients with atrial fibrillation(AF) undergoing catheter ablation with a lattice-tip PFA catheter or with radiofrequency (RF) (50/90 W) were eligible. Changes in haptoglobin, hemoglobin(Hb), lactate dehydrogenase(LDH), indirect bilirubin, and creatinine were assessed in blood samples collected at baseline (T0), immediately (T1), and 24-h (T2) post-ablation. Clinically relevant IH was defined as changes in biochemical markers of hemolysis in combination with a hemoglobin drop ≥ 2 g/dL or renal biomarker changes fulfilling criteria for AKI. Furthermore, in order to properly interpret the observed changes in haptoglobin, \\\"biochemical events\\\" previously associated with direct markers of IH were analyzed [(T2 haptoglobin ≤ 0.25 g/l, T2/T0 haptoglobin ratio < 0.85, and T2-T0 haptoglobin difference < Q1 (-0.1 g/l)].</p><p><strong>Results: </strong>A total of 142 patients [102/142 (72%) in PFA group; 40/142 (28%) in RF group] were included, with comparable characteristics. Significant changes in Hb and LDH were found in both groups. The PFA group experienced a greater decrease in haptoglobin levels compared to RF (MD = -0.02 g/L, 95% CI [-0.04, 0]; p = 0.043), while \\\"biochemical events\\\" were infrequent and similar between groups. None of the participants fulfilled the definition of clinically relevant IH. In the PFA group, the number of lesions was marginally associated with greater biomarker changes.</p><p><strong>Conclusions: </strong>In this observational real-world cohort, the lattice-tip PFA catheter was associated with statistically significant, yet relatively small reductions of haptoglobin post-procedurally compared to RF, with no case of clinically relevant IH being reported.</p>\",\"PeriodicalId\":520675,\"journal\":{\"name\":\"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-10-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s10840-025-02163-z\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s10840-025-02163-z","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：血管内溶血（IH）是脉冲场消融（PFA）技术的固有局限性。IH的严重程度是多因素的，在PFA系统之间是不同的。本研究旨在评估格尖PFA导管诱导IH的生化证据及临床意义。方法：心房颤动（AF）患者采用点阵尖端PFA导管或射频（RF） （50/90 W）消融。在消融后基线（T0）、立即（T1）和24小时（T2）采集的血液样本中评估接触珠蛋白、血红蛋白（Hb）、乳酸脱氢酶（LDH）、间接胆红素和肌酐的变化。临床相关IH被定义为溶血生化指标的变化，并伴有血红蛋白下降≥2 g/dL或肾脏生物标志物的变化，符合AKI的标准。此外，为了正确解释所观察到的触珠蛋白变化，我们分析了先前与IH直接标志物相关的“生化事件”[(T2触珠蛋白≤0.25 g/l， T2/T0触珠蛋白比值]结果：PFA组共142例患者[102/142 (72%)]；RF组纳入40/142例（28%），具有可比性。两组患者Hb和LDH均有显著变化。与RF组相比，PFA组的触珠蛋白水平下降幅度更大（MD = -0.02 g/L, 95% CI [-0.04, 0]; p = 0.043），而“生化事件”较少且组间相似。没有参与者符合临床相关IH的定义。在PFA组中，病变数量与较大的生物标志物变化略有相关。结论：在这个观察性的现实世界队列中，与射频相比，格尖PFA导管与术后触珠蛋白的减少有统计学意义，但相对较小，没有临床相关的IH病例报告。
Biochemical evidence and clinical significance of hemolysis following catheter ablation with a lattice-tip PFA catheter.
Background: Intravascular hemolysis(IH) is an inherent limitation of pulsed field ablation(PFA) technology. The severity of IH is multifactorial and differs between PFA systems. This study aimed to assess the biochemical evidence and clinical significance of IH induced by a lattice-tip PFA catheter.
Methods: Patients with atrial fibrillation(AF) undergoing catheter ablation with a lattice-tip PFA catheter or with radiofrequency (RF) (50/90 W) were eligible. Changes in haptoglobin, hemoglobin(Hb), lactate dehydrogenase(LDH), indirect bilirubin, and creatinine were assessed in blood samples collected at baseline (T0), immediately (T1), and 24-h (T2) post-ablation. Clinically relevant IH was defined as changes in biochemical markers of hemolysis in combination with a hemoglobin drop ≥ 2 g/dL or renal biomarker changes fulfilling criteria for AKI. Furthermore, in order to properly interpret the observed changes in haptoglobin, "biochemical events" previously associated with direct markers of IH were analyzed [(T2 haptoglobin ≤ 0.25 g/l, T2/T0 haptoglobin ratio < 0.85, and T2-T0 haptoglobin difference < Q1 (-0.1 g/l)].
Results: A total of 142 patients [102/142 (72%) in PFA group; 40/142 (28%) in RF group] were included, with comparable characteristics. Significant changes in Hb and LDH were found in both groups. The PFA group experienced a greater decrease in haptoglobin levels compared to RF (MD = -0.02 g/L, 95% CI [-0.04, 0]; p = 0.043), while "biochemical events" were infrequent and similar between groups. None of the participants fulfilled the definition of clinically relevant IH. In the PFA group, the number of lesions was marginally associated with greater biomarker changes.
Conclusions: In this observational real-world cohort, the lattice-tip PFA catheter was associated with statistically significant, yet relatively small reductions of haptoglobin post-procedurally compared to RF, with no case of clinically relevant IH being reported.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
