Pulsed field ablation was associated with greater biochemical hemolysis than thermal ablation but showed no statistically significant increase in acute kidney injury (RR 2.00; 95% CI 0.5-7.9).
Meta-Analysis (n=4,307)
Does pulsed field ablation increase the risk of hemolysis and acute kidney injury compared to thermal ablation in patients with atrial fibrillation?
In patients undergoing ablation for atrial fibrillation, pulsed field ablation causes greater biochemical hemolysis than thermal ablation, but this does not translate into a statistically significant increase in acute kidney injury.
Effect estimate: RR 2.00 (95% CI 0.5-7.9)
ABSTRACT Purpose Evaluate the comparative risk of hemolysis and acute kidney injury (AKI) with pulsed field ablation (PFA) versus thermal ablation (TA) for atrial fibrillation. Methods Databases were searched through June 2025 for comparative studies reporting hemolysis markers or renal outcomes. Random‐effects models estimated risk ratios (RRs) and mean differences (MDs). Results Eight studies ( n = 4307) were included. Compared with TA, PFA was not associated with a statistically significant increase in AKI (RR 2.00, 95% CI 0.5–7.9) or change in creatinine (MD 0.02 mg/dL, p = 0.10). PFA was associated with higher LDH (MD +72 U/L p < 0.001) and lower haptoglobin (MD −0.60 g/L p < 0.001). Conclusions PFA may be associated with greater biochemical hemolysis than TA; however, no statistically significant difference in AKI or post‐procedural creatinine was observed in pooled analyses.
Erazo et al. (Fri,) conducted a meta-analysis in Atrial fibrillation (n=4,307). Pulsed field ablation (PFA) vs. Thermal ablation (TA) was evaluated on Acute kidney injury (AKI) (RR 2.00, 95% CI 0.5-7.9). Pulsed field ablation was associated with greater biochemical hemolysis than thermal ablation but showed no statistically significant increase in acute kidney injury (RR 2.00; 95% CI 0.5-7.9).