Hemolysis and renal safety of pulsed-field vs thermal ablation for atrial fibrillation: A systematic review and meta-analysis
HEART RHYTHM, cilt.23, sa.8, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 23 Sayı: 8
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.hrthm.2026.01.026
- Dergi Adı: HEART RHYTHM
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Background: Pulsed-field ablation (PFA) is a non-thermal modality for atrial fibrillation (AF) ablation; concerns persist regarding intravascular hemolysis and acute kidney injury (AKI). Objective: This study aimed to compare biomarker-defined hemolysis and clinical AKI after PFA vs thermal ablation. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent systematic review and random-effects meta-analysis of comparative observational studies in adults undergoing AF ablation. Major databases and trial registries were searched. Risk of bias was assessed with the Risk of Bias in Non-Randomized Studies of Interventions tool. Co-primary outcomes were change-from-baseline hemolysis biomarkers (lactate dehydrogenase [LDH], haptoglobin, bilirubin) and AKI incidence (preferentially Kidney Disease: Improving Global Outcomes-defined). Results: 12 studies (n = 5158; AKI analysis n = 4884; 2122 PFA, 2762 thermal) met criteria. Compared with thermal ablation, PFA produced significantly greater hemolysis: LDH mean difference (MD) +63.79 U/L (P < .001); haptoglobin MD -0.30 g/L (P = .036); bilirubin MD +1.91 mu mol/L (P = .023). AKI risk did not differ (risk ratio [RR], 1.14; 95% confidence interval [CI], 0.42-3.12; P = .80; absolute rates 3.5% vs 3.1%). PFA was associated with significantly lower major bleeding (RR, 0.15; 95% CI, 0.04-0.62; P = .009) and shorter procedure time (MD, -25.81 min; 95% CI, -49.26 to -2.36; P = .031). Hemolysis magnitude varied by PFA platform; AKI did not. Limitations include observational designs and heterogeneity. 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.