Arrhythmias & electrophysiologyCohort study
Acute kidney injury related to pulsed field ablation of atrial fibrillation: Protective role of the protocol-based hydration regimen
- prospective analysis of consecutive patients
- unselected patient cohort
- pentaspline catheter
Authors' conclusion
AKI after PFA occurs in approximately 6.4% of patients, predominantly mild cases. The risk increases with CKD, extensive ablation, and high PF pulse counts. Protocol-driven peri-procedural hydration substantially reduces the risk of AKI.
Study context
- Population
- Unselected patients undergoing pulsed field ablation (PFA) of atrial fibrillation (AF) with a pentaspline catheterconsecutive patients treated with PFA · without hydration 232 · hydration protocol 269
- Participants
- 501 patients
- Exposure
- Protocol-based hydration regimen vs no hydration
- Without hydrationn = 232
- Hydration protocoln = 269
Main finding
As reported in the abstract
AKI incidence
Acute kidney injury (AKI)
6.4% (32 of 501)
AKI 1
3.8%
AKI 2
1.4%
AKI 3
1.2%
Observational data: associations, not effects.
Further findings
AKI risk factors (multivariable analysis)
| Comparison | OR (95% CI) | P value | |
|---|---|---|---|
| chronic kidney disease (CKD) | 3.29 (1.45–7.46) | P = 0.005 | |
| extensive left atrial ablation | 6.67 (1.47–63.79) | P = 0.01 | |
| hydration · protective | 0.33 (0.14–0.75) | P = 0.008 | |
| 0.050.21520Odds ratio (log scale) |
| Outcome | Values | OR (per 10 applications) (95% CI) | P value | |
|---|---|---|---|---|
| AKI risk factors (multivariable analysis) — higher number of PF applications | 1.37 (1.17–1.61) | P < 0.001 | ||
| 0.512Odds ratio (log scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| Mean number of PF applications, patients with vs without AKI | Patients with AKI mean 105.1 ± 26.2 · Patients without AKI mean 73.4 ± 22.2 |
- Mean number of PF applications, patients with vs without AKI: P < .001
Predictive modeling for AKI risk
- 5% risk in non-CKD
- 118 pulses
- 5% risk in patients with chronic kidney disease (CKD)
- 78 pulses
Original publication
Acute kidney injury related to pulsed field ablation of atrial fibrillation: Protective role of the protocol-based hydration regimen. Heart Rhythm. Published 7 April 2026. doi:10.1016/j.hrthm.2026.03.1963
Summarised from the published abstract; every number is checked against it