Severe acute kidney injury related to hemolysis after pulsed field ablation for atrial fibrillation.

BACKGROUND AND AIMS: Pulsed-field ablation (PFA) has been proposed as a novel alternative to radiofrequency and cryoablation in the treatment of atrial fibrillation (AF). Following the occurrence of two cases of acute kidney injury secondary to hemolysis after PFA procedure, we evaluated hemolysis in a cohort of consecutive patients.

METHODS AND RESULTS: Two cases of AKI occurred in last May and June 2023. AKI was secondary to acute and severe hemolysis, after a PFA procedure. From June 2023, a total of 68 consecutive patients (64.3 ±10.5 years) undergoing AF ablation with PFA were enrolled in the study. All patients had a blood sample the day after the procedure for the assessment of hemolysis indicators. The pentaspline PFA catheter was used with a total number of applications median of 75 (62 ; 127). Nineteen patients (28%) showed significantly depleted haptoglobin level (<0.04g/L). A significant inverse correlation was found between plasma level of haptoglobin and the total number of applications. Two groups were compared: The hemolysis + group (haptoglobin<0.04 g/L) vs the Hemolysis - group. The total number of applications was significantly higher in the Hemolysis + group. More than 70 applications seem to have the better sensivity and specificity to predict hemolysis.

CONCLUSION: Intravascular hemolysis can occur after certain procedures of PFA. AKI is a phenomenon that appears to be very rare after a PFA procedure. However, caution must be exercised in the number of applications to avoid severe hemolysis.