Hemolysis after pulsed field ablation in pulmonary vein isolation: a prospective controlled trial

Abstract Introduction and Aim Intravascular hemolysis with consecutive acute kidney injury (AKI) has been described after pulsed field ablation (PFA) in atrial fibrillation (AF). The aim of this study was to evaluate the risk of intravascular hemolysis and AKI after PFA with different numbers and forms of applications. Methods During May 2022 to August 2024 consecutive patients undergoing AF ablation were prospectively enrolled in four groups, including equally distributed numbers of patients undergoing PFA (pentaspline) with eight applications (PFA-8), with 16 applications (PFA-16), CardioFocus focal PFA (PFA-FOC) and radiofrequency ablation (RFA). Blood samples were collected immediately before and after the ablation, as well as on the following day to analyze hemolysis markers (total bilirubin, lactate dehydrogenase (LDH) and potassium) and indicators for AKI (serum creatinine, estimated glomerular filtration rate and serum urea). Results A total of 200 patients (68.4 ± 10.8 years) could be included in the final analysis. The blood samples revealed a significant increase in total bilirubin and LDH across all PFA modalities and RFA 24 hours after ablation compared to baseline levels. Potassium levels increased significantly in all PFA modalities immediately post-ablation as compared to baseline, followed by a return to approximately baseline after 24 hours. No significant potassium fluctuations were observed in RFA. Serum creatinine levels showed no significant increase in any PFA modality or RFA within the 24-hour assessment period. Conclusion PFA with a specified number of applications for AF treatment appears safe showing no significant risk of AKI despite the significant increase of hemolysis markers. In addition, no dose-dependent increase in hemolysis markers was observed across the different PFA modalities in our study setup. Further research involving a larger patient cohort and varying PFA application forms and doses is needed to confirm these findings and to assess their implications for the safety and efficacy of AF treatment.Hemolysis and Kidney Function after PVI