Arrhythmias & electrophysiology
Hemolysis and renal safety of pulsed-field vs thermal ablation for atrial fibrillation: A systematic review and meta-analysis
Authors' conclusion
PFA increases biomarker-defined intravascular hemolysis relative to thermal ablation without increasing population-level AKI. Coupled with reduced major bleeding and enhanced procedural efficiency, these data support PFA use; dose discipline, hydration, and platform selection remain important for high-risk patients.
Study context
- Population
- Adults undergoing atrial fibrillation (AF) ablation12 studies, acute kidney injury (AKI) analysis n = 4884
- Participants
- 5,158 adults
- Comparison
- Pulsed-field ablation (PFA) vs thermal ablation
- PFAn = 2,122
- Thermal ablationn = 2,762reference
- Outcome
- Co-primary: change-from-baseline hemolysis biomarkers (LDH, haptoglobin, bilirubin) and AKI incidence
Methodological detailsPreferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent, Risk of Bias in Non-Randomized Studies of Interventions tool
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent
- Risk of Bias in Non-Randomized Studies of Interventions tool
Pooled result
As reported in the abstract
PFA vs thermal ablationRelative risk (95% CI)P value
AKI
1.14(0.42–3.12)
P = 0.80- LDH
- MD +63.79 U/L; P < 0.001
- Haptoglobin
- MD −0.30 g/L; P = 0.036
- Bilirubin
- MD +1.91 μmol/L; P = 0.023
Further pooled results
| Outcome | MD (min) (95% CI) | P value | |
|---|---|---|---|
| Procedure time | −25.81 (−49.26 to −2.36) | P = 0.031 | |
| −60−40−20020Difference, min (linear scale) |
Hemolysis and AKI by PFA platform (subgroup)
- Hemolysis magnitude varied by PFA platform; AKI did not
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Major bleeding | 0.15 (0.04–0.62) | P = 0.009 | |
| 0.050.21520Relative risk (log scale) |
Original publication
Hemolysis and renal safety of pulsed-field vs thermal ablation for atrial fibrillation: A systematic review and meta-analysis. Heart Rhythm. Published 23 January 2026. doi:10.
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