The Protective Impact of Gd-DTPA on Hemolysis in Pulsed Field Ablation for Atrial Fibrillation

Abstract

Pulsed field ablation (PFA) is a promising nonthermal method for treating atrial fibrillation. However, the potential for erythrocyte rupture and subsequent hemolysis remains a significant concern, particularly with high-intensity applications. In this study, we explored the protective effects of gadolinium-diethylenetriamine-penta-acetic acid (Gd-DTPA), a common magnetic resonance imaging contrast agent, against PFA-induced hemolysis both in vitro and in vivo. Our in vitro experiments involved subjecting fresh heparinized rat blood to PFA in the presence of various concentrations of Gd-DTPA. We found that Gd-DTPA concentrations of 100 μM and 1,000 μM significantly mitigated hemolysis caused by PFA application. For in vivo studies, rats were administered Gd-DTPA at dosages of 10 μmol/kg and 100 μmol/kg before PFA. The results indicated that preadministration of Gd-DTPA effectively reduced erythrocyte destruction and intravascular hemolysis after PFA. The protective effect of Gd-DTPA is attributed to its ability to stiffen erythrocyte membranes, rendering them more resistant to the destabilizing effects of PFA-induced electroporation. These findings suggest that Gd-DTPA could play a crucial role in minimizing hemolysis and associated complications in clinical applications of PFA for atrial fibrillation. Further studies are needed to confirm these protective effects in larger animal models and eventually in clinical settings.

Keywords: GD-DTPA; atrial fibrillation; hemolysis; pulsed field ablation.