Acute kidney injury requiring dialysis occurred after pulmonary vein isolation with pulsed field ablation, highlighting the risk despite minimal hemolysis.
Severe acute kidney injury requiring dialysis can occur after pulsed field ablation for atrial fibrillation even with a standard number of applications (40) and minimal systemic hemolysis.
Absolute Event Rate: 0% vs 0%
Abstract Background Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) has emerged as a promising treatment for atrial fibrillation (AF). However, hemolysis-induced acute kidney injury (AKI) remains a concern, particularly with higher numbers of applications. Case Summary We report the case of a 62-year-old male with a history of CABG who underwent PVI using a 35mm pentaspline PFA catheter. Pre-procedural CT imaging revealed a large 37mm left common PV ostium. Standard energy delivery protocols were followed, including two “olive” applications per vein. The patient was discharged the same day. That evening, he developed dark “cola-colored” urine. Upon remote consultation the next day, he was advised to increase fluid intake to 3L that day. His urine color normalized by the following day, but he experienced a 3kg weight gain and oliguria and presented to the emergency department. Laboratory tests showed severe AKI (eGFR to 6 mL/min/1.73m²), necessitating urgent dialysis. Laboratory results showed modest but clinically relevant elevation of hemolysis markers, while urine analysis showed breakdown product of erythrocytes. After several hemodialysis sessions, the patient’s urine output improved, and he was eventually discharged. Two months after the procedure, his renal function recovered to normal values. Discussion While prior experience suggests that limiting PFA applications to fewer than 70 may reduce the risk of hemolysis-associated renal injury, this case demonstrates that even with 40 applications and minimal systemic hemolysis, AKI requiring dialysis can occur. This highlights the need for heightened vigilance, early fluid management, and prompt intervention to support renal recovery after PFA.
Mulder et al. (Sat,) reported a other. Acute kidney injury requiring dialysis occurred after pulmonary vein isolation with pulsed field ablation, highlighting the risk despite minimal hemolysis.