Severe acute kidney injury related to haemolysis after pulsed field ablation for atrial fibrillation

• DOI: 10.1093/europace/euad371
• Publication Date: 2024-01-04T17:59:50Z
• Authors: Sandrine Venier; Nathan Vaxelaire; Peggy Jacon; Adrien Carabelli; Antoine Desbiolles; Frederic Garban; Pascal Defaye
• Keywords: 0301 basic medicine; 03 medical and health sciences; Treatment Outcome; Haptoglobins; Clinical Research; Pulmonary Veins; Atrial Fibrillation; Catheter Ablation; Humans; Acute Kidney Injury; Hemolysis

Abstract

Aims Pulsed field ablation (PFA) has been proposed as a novel alternative to radiofrequency (RF) and cryoablation in the treatment of atrial fibrillation (AF). Following the occurrence of two cases of acute kidney injury (AKI) secondary to haemolysis after a PFA procedure, we evaluated haemolysis in a cohort of consecutive patients.

Methods and results Two cases of AKI occurred in last May and June 2023. AKI was secondary to acute and severe haemolysis after a PFA procedure. From June 2023, a total of 68 consecutive patients (64.3 ± 10.5 years) undergoing AF ablation with PFA were enrolled in the study. All patients had a blood sample the day after the procedure for the assessment of haemolysis indicators. The pentaspline PFA catheter was used with a total number of median applications of 64 (54; 76). Nineteen patients (28%) showed significantly depleted haptoglobin levels (<0.04 g/L). A significant inverse correlation was found between the plasma level of haptoglobin and the total number of applications. Two groups were compared: the haemolysis+ group (haptoglobin < 0.04 g/L) vs. the haemolysis− group. The total number of applications was significantly higher in the haemolysis+ group vs the haemolysis - group respectively 75 (62; 127) vs 62 (54; 71) P = 0.011. More than 70 applications seem to have better sensitivity and specificity to predict haemolysis.

Conclusion Intravascular haemolysis can occur after certain procedures of PFA. Acute kidney injury is a phenomenon that appears to be very rare after a PFA procedure. However, caution must be exercised in the number of applications to avoid severe haemolysis.