ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1681098
Balloon vs. Balloon – Comparison of Hemolysis and Renal Markers After Cryoballoon vs. Ballon-In-Basket Pulsed Field Pulmonary Vein Isolation
Provisionally accepted
Jan-Per Wenzel*
Raed AbdessadokSascha HatahetCharlotte EitelJulius NikorowitschRoman MamaevSorin PopescuSamuel ReinckeAnna TraubBehnam SubinSuzanne De WahaTanja ZellerKarl-Heinz KuckRoland Richard Tilz- Department of Rhythmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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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 versus 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.
Keywords: Balloon catheter, Cryoablation, pulsed field ablation, Hemolysis, Renal function
Received: 06 Aug 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Wenzel, Abdessadok, Hatahet, Eitel, Nikorowitsch, Mamaev, Popescu, Reincke, Traub, Subin, De Waha, Zeller, Kuck and Tilz. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jan-Per Wenzel, Department of Rhythmology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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