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Hemolysis and Renal Outcomes After Pulsed Field Versus Thermal Ablation for Atrial Fibrillation: A Meta‐Analysis

Year: 2026

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: PURPOSE: Evaluate the comparative risk of hemolysis and acute kidney injury (AKI) with pulsed field ablation (PFA) versus thermal ablation (TA) for atrial fibrillation. METHODS: Databases were searched through June 2025 for comparative studies reporting hemolysis markers or renal outcomes. Random-effects models estimated risk ratios (RRs) and mean differences (MDs). RESULTS: Eight studies (n = 4307) were included. Compared with TA, PFA was not associated with a statistically significant increase in AKI (RR 2.00, 95% CI 0.5-7.9) or change in creatinine (MD 0.02 mg/dL, p = 0.10). PFA was associated with higher LDH (MD +72 U/L p < 0.001) and lower haptoglobin (MD -0.60 g/L p < 0.001). CONCLUSIONS: PFA may be associated with greater biochemical hemolysis than TA; however, no statistically significant difference in AKI or post-procedural creatinine was observed in pooled analyses.

Source: Pacing and Clinical Electrophysiology

DOI: 10.1111/pace.70225