ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Biomarker Response to Balloon-in-Basket Pulsed Field Ablation: Does Posterior Wall Isolation Matter?
Sascha Hatahet 1
Sorin Popescu 1
Charlotte Eitel 1
Suzanne de Waha 1
Tanja Zeller 2,3
Karl-Heinz Kuck 1
Jan-Per Wenzel 1,3
Roland Richard Tilz 1,3
1. Department of Rhythmology, Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany, Lübeck, Germany
2. Institute for Cardiogenetics, University Hospital Schleswig-Holstein, Lübeck, Germany, Lübeck, Germany
3. German Center for Cardiovascular Research (DZHK), Partner Site Lübeck, Germany, Lübeck, Germany
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Abstract
Background: A novel balloon-in-basket pulsed field ablation (BiB-PFA) catheter enables efficient pulmonary vein isolation (PVI) and allows posterior wall isolation (PWI) within the same procedure. The incremental biological effect of PWI compared to PVI alone remains uncertain, particularly regarding inflammation, myocardial injury, and hemolysis. Methods: In this prospective, single-center study, consecutive patients with atrial fibrillation underwent first-time BiB-PFA, either PVI only or PVI plus PWI. Venous blood samples were collected before and one day after ablation. Biomarkers included leukocytes, platelets, hemoglobin, C-reactive protein (CRP), haptoglobin, bilirubin, lactate dehydrogenase (LDH), creatinine, estimated glomerular filtration rate (GFR), myoglobin, creatine kinase (CK), and troponin T. Results: A total of 60 patients were enrolled (PVI only n=30, PVI+PWI n=30). Baseline characteristics were comparable. PVI+PWI required more applications (19 vs. 16; p<0.001) but had similar procedure time. Both groups showed significant increases in inflammatory (CRP, leukocytes), myocardial (troponin T, CK, LDH, myoglobin), and hemolysis markers (bilirubin, LDH, haptoglobin changes; all p<0.001). However, the magnitude of biomarker release did not differ between PVI only and PVI+PWI: Δ troponin T (1154 vs. 1029 ng/L, p=0.694), Δ CK (217 vs. 197 U/L, p=0.652), Δ CRP (2.7 vs. 3.4 mg/L, p=0.475), Δ bilirubin (2.4 vs. 2.8 µmol/L, p=0.842), Δ creatinine (3.3 vs. 9.0 µmol/L, p=0.085). Conclusion: BiB-PFA PVI provokes systemic responses involving inflammation, myocardial injury, and hemolysis. Adjunctive PWI increases application number but does not further increase biomarker release, supporting the biological safety of PWI.
Summary
Keywords
Atrial Fibrillation, Hemolysis, Inflammation, Myocardial injury, PFA, platelets, posterior wall isolation, PVI
Received
27 October 2025
Accepted
12 February 2026
Copyright
© 2026 Hatahet, Popescu, Eitel, de Waha, Zeller, Kuck, Wenzel 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: Sascha Hatahet
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