Hemolysis in Pulsed Field Ablation for Atrial Fibrillation: A Narrative Review

Area of Science:

• Cardiology
• Nephrology
• Biomedical Engineering

Background:

• Pulsed field ablation (PFA) is a novel non-thermal energy source for atrial fibrillation (AF) treatment.
• PFA offers comparable efficacy to thermal ablation with a potentially improved safety profile.
• Emerging evidence links PFA to intravascular hemolysis, a complication that may cause acute kidney injury (AKI).

Purpose of the Study:

• To review the mechanisms underlying PFA-induced hemolysis.
• To summarize current strategies for mitigating the risk of AKI following PFA.
• To provide a comprehensive overview of PFA-related hemolysis and AKI prevention.

Main Methods:

• Literature review of studies investigating PFA, hemolysis, and AKI.
• Analysis of mechanisms of red blood cell lysis induced by electrical pulses.
• Summary of clinical data on procedural variables influencing hemolysis.
• Evaluation of preventive strategies for AKI.

Main Results:

• PFA's electrical pulses can cause red blood cell lysis, increasing free hemoglobin.
• Hemolysis extent correlates with peak voltage, catheter contact, and number of energy applications.
• Preprocedural hydration aids renal clearance of hemolytic products, reducing AKI incidence.

Conclusions:

• PFA-induced hemolysis is an inherent effect of the ablation modality.
• AKI is a significant clinical consequence of PFA-related hemolysis.
• Preventive measures, particularly hydration, can substantially decrease the incidence of AKI.