Arrhythmias & electrophysiologyCohort study
Hemolysis and kidney injury after catheter ablation for atrial fibrillation: Microsecond vs nanosecond pulsed field ablation
- Observational study
- single high-volume Chinese center
Authors' conclusion
PFA for atrial fibrillation typically induced hemolysis; however, the application-related dose effect was observed in microPFA, but not in nanoPFA. NanoPFA was associated with lower hemolysis indices, whereas severe anemia and AKI may be rare. Larger studies are needed to confirm modality differences, define clinical impact, and optimize application titration.
Study context
- Population
- Patients who underwent atrial fibrillation ablationpatients included · microPFA 186 · nanoPFA 65 · radiofrequency ablation (RFA) 72
- Participants
- 323 patients
- Exposure
- hemolysis and acute kidney injury (AKI) after microPFA, nanoPFA, and radiofrequency ablation (RFA)
- microPFAn = 186
- nanoPFAn = 65
- RFAn = 72
Main finding
As reported in the abstract
Hemolysis
- Pulsed field ablation (PFA) produced obvious hemolysis, which was not observed with RFA
- Postablation bilirubin, lactate dehydrogenase (LDH), and free hemoglobin increased and haptoglobin decreased with PFA
Observational data: associations, not effects.
Further findings
| Outcome | microPFA | nanoPFA | RFA | P value |
|---|---|---|---|---|
| LDH · postablation · higher with microPFA · after multivariable adjustment | 229.0 ± 50.6 IU/L | 198.4 ± 33.8 IU/L | Not reported in the abstract | P < 0.001 |
| Free hemoglobin · postablation · higher with microPFA · after multivariable adjustment | 289.3 ± 45.1 ng/mL | 263.7 ± 55.0 ng/mL | Not reported in the abstract | P = 0.043 |
Hemolysis vs delivery number (microPFA)
- LDH ratio r
- 0.26; 95% confidence interval 0.10-0.40
- bilirubin ratio r
- 0.15; 95% confidence interval 0-0.29
- no dose-dependent association was detected with nanoPFA
Safety
Hemoglobin decline and hemoglobin drop of >20 g/L
Hemoglobin decline
hemoglobin drop of >20 g/L
events
| Outcome | microPFA | nanoPFA | RFA |
|---|---|---|---|
| AKI · AKI was uncommon | 3 | 1 | 0 |
Original publication
Hemolysis and kidney injury after catheter ablation for atrial fibrillation: Microsecond vs nanosecond pulsed field ablation. Heart Rhythm. Published 31 March 2026. doi:10.1016/j.hrthm.2026.03.1941
Summarised from the published abstract; every number is checked against it