Key result
Pulsed field ablation induces haemolysis with elevated LDH, but acute kidney injury remains rare.
Why the study?
Recent studies have described potential haemolysis and acute kidney injury caused by pulsed field ablation for atrial fibrillation, raising safety concerns.
Does pulsed field ablation induce haemolysis and acute kidney injury in patients undergoing atrial fibrillation ablation?
Meta-Analysis (n=1,292)
Does pulsed field ablation induce haemolysis and acute kidney injury in patients undergoing atrial fibrillation ablation?
Mean Difference: -123.63 (95% CI -194.54–-52.71)
Pulsed field ablation for atrial fibrillation induces transient, subclinical haemolysis but is not associated with significant acute kidney injury or clinically meaningful anaemia.
BACKGROUND & AIMS Despite atrial fibrillation ablation showing promise, recent studies have described the potential induction of haemolysis and onset of acute kidney injury (AKI) caused by pulsed field ablation (PFA) raising safety concerns. This study aimed to evaluate the changes in haemolysis and renal function biomarker following the ablation. METHODS We systematically searched PubMed, ScienceDirect, and Cochrane Library for observational and randomised controlled trials up to 16 July 2025. We calculated the changes using the difference between pre- and post-ablation biomarker levels. Generic inverse variance was used with 95% confidence interval (CI). Data measures were mean difference (MD) and pooled using a random effects model. RESULTS Ten observational studies with 1,292 patients were included. PFA is associated with haemolysis reflected on significant increase in lactate dehydrogenase (MD -123.63, 95% CI -194.54 to -52.71), bilirubin (MD -0.82, 95% CI -1.44 to -0.20), and free plasma haemoglobin (MD -47.50, 95% CI -62.36 to -32.65) together with a reduction of haptoglobin (MD 0.58, 95% CI 0.23 - 0.94) following the ablation resulting reduced red blood cell (MD 0.19, 95% CI 0.03 to 0.35), haemoglobin (MD 0.99, 95% CI 0.62 to 1.36), and haematocrit (MD 2.79, 95% CI 1.10 to 4.49). However, there were no difference in urea (MD -0.20, 95% CI -1.17 to 0.77), creatinine (MD -0.07, 95% CI -0.14 to 0.00), and estimated glomerular filtration rate (MD -2.63, 95% CI -6.65 to 1.39). CONCLUSIONS Despite significant haemolysis-related biomarker changes after PFA, no clinically meaningful anaemia occurred, and AKI was rare and transient. Renal risk appears to depend on application and baseline renal vulnerability, while post-ablation hydration may serve as a preventive strategy against AKI. Further optimisation of PFA and peri-procedural management is needed to enhance safety.
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Baravia et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=1,292). Pulsed field ablation vs. Pre-ablation baseline was evaluated on Change in lactate dehydrogenase (MD -123.63, 95% CI -194.54 to -52.71). Pulsed field ablation significantly increased lactate dehydrogenase (MD -123.63; 95% CI -194.54 to -52.71) and other haemolysis biomarkers, but acute kidney injury was rare and transient.
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