%0 Journal Article
%T Significant hemolysis is present during irreversible electroporation of cardiomyocytes in vitro.
%A Fiserova I
%A Fiser O
%A Novak M
%A Trnka J
%A Gibalova A
%A Kvapil D
%A Bacova B
%A Hozman M
%A Herman D
%A Benesova K
%A Osmancik P
%J Heart Rhythm
%V 0
%N 0
%D 2024 Aug 13
%M 39147303
%F 6.779
%R 10.1016/j.hrthm.2024.08.019
%X <B>BACKGROUND: </B>Pulsed field ablation (PFA) of atrial fibrillation is a new method in clinical practice. Despite a favorable safety profile of PFA in atrial fibrillation ablation, rare cases of renal failure, probably due to hemolysis, have recently been reported.<BR><B>OBJECTIVE: </B>The aim of this study was to determine the rate of hemolysis and cardiac cell death during in vitro PFA with different electric field intensities.<BR><B>METHODS: </B>Blood samples from healthy volunteers and mouse HL-1 cardiomyocyte cell lines were subjected to in vitro irreversible electroporation using 216 bipolar pulses, each lasting 2 μs with intervals of 5 μs, repeated 20 times at a frequency of 1 Hz. These pulses varied from 500 V to 1500 V. Cell-free hemoglobin levels were assessed spectrophotometrically, and red blood cell microparticles were evaluated by flow cytometry. Cardiomyocyte death was quantified with propidium iodide.<BR><B>RESULTS: </B>Pulsed field energy (1000 V/cm, 1250 V/cm, and 1500 V/cm) was associated with a significant increase in cell-free hemoglobin (0.32 ± 0.16 g/L, 2.2 ± 0.96 g/L, and 5.7 ± 0.39 g/L; P < .01) and similar increase in the concentration of red blood cell microparticles. Significant rates of cardiomyocyte death were observed at electric field strengths of 750 V/cm, 1000 V/cm, 1250 V/cm, and 1500 V/cm (26.5% ± 5.9%, 44.3% ± 6.2%, 55.5% ± 6.9%, and 74.5% ± 17.8% of cardiomyocytes; P < .01).<BR><B>CONCLUSIONS: </B>The most effective induction of cell death in vitro was observed at 1500 V/cm. This intensity was also associated with a significant degree of hemolysis.