Abstract 4141921: Hydration to prevent acute kidney injury after pulsed field ablation: importance of timing and fluids amount

Previous studies have highlighted the risk of acute kidney injury (AKI) development, underlining the need for strategies to mitigate this complication. We analyzed 208 consecutive patients who underwent pulsed field ablation (PFA) for post-FDA approval. All patients received pulmonary vein isolation. Ablation of extra-PV sites was performed per the operator’s choice, with no contrast agents . Serum creatinine was measured in all patients at baseline and 24 after ablation. The aim of our study was to evaluate the impact of hydration timing and the amount of fluids on incidence of AKI in patients undergoing PFA. Group means for continuous variables were compared using the Student t-test. Categorical variables were compared using the Chi-square test. A ROC analysis was done to evaluate the predictive model of PFA applications to evaluate AKI. All tests were two-tailed and conducted at an α level of 0.05. We divided patients into two groups: Group 1 (n=102) received either one liter of saline pre-procedure or one liter pre-procedure followed by a liter post-procedure; Group 2 (n=106) was preemptively hydrated with two liters of saline before the procedure, followed by additional 500cc if the patient had received more than 100 PF applications. Baseline Characteristics of population are described in Fig.1a . In the comparative analysis of the two groups, there was no significant difference regarding the number of PFA applications administered. None of the patients in Group 2 experienced AKI, while Group 1 AKI occurred in 9 patients. (0/106 vs 9/102, p-value=0.0034). The ROC analysis yielded an area under the curve of 0.709 ± 0.107 with a 95% confidence interval ranging from 0.498 to 0.919 (p-value=0.035). An optimal PF application cutoff point of 105.50 was determined, associating a higher probability of AKI with PFA applications exceeding this threshold (sensitivity:0.667, specificity:0.735, Youden's index:0.402) ( Fig.1b ). Among the 9 patients who developed AKI, we observed that 7 received more than 100PF applications; the remaining 2 patients, each with baseline stage 3 chronic kidney disease and prior episodes of AKI following surgeries, received 54 and 50PF applications, respectively. In this series of patients, pre-procedural hydration with two liters of fluids eliminated the risk of AKI even in patients who received a high number of PFA applications.