Patient vulnerability associated with acute kidney injury after pulsed field ablation: A role for baseline biomarkers and haptoglobin phenotype.

BACKGROUND

Excessive pulsed field ablation (PFA) applications for atrial fibrillation (AF) have been associated with hemolysis-related acute kidney injury (AKI); however, severe AKI can occur when application counts remain within conventional practice ranges.

OBJECTIVE

In this study, we investigated baseline patient characteristics associated with postprocedural AKI development after PFA for AF.

METHODS

Consecutive patients with AF who underwent PFA with a circular-array or pentaspline catheter were prospectively enrolled. AKI was defined as a serum creatinine increase of ≥0.3 mg/dL or ≥1.5 times baseline. We assessed whether patient characteristics, procedural factors, and periprocedural biomarkers (free plasma hemoglobin, haptoglobin, lactate dehydrogenase [LDH], and indirect bilirubin) were associated with AKI occurrence.

RESULTS

Of 216 patients who underwent PFA (median 54 applications [interquartile range 44-67]), AKI occurred in 7 (3.2%); all events were classified as Kidney Disease: Improving Global Outcomes stage 1 and resolved within 1 month. Compared with the non-AKI group, the AKI group had lower estimated glomerular filtration rate (43.8 [39.2-48.5] vs 59.7 [49.3-70.3] mL/min/1.73 m2; P = .026), lower haptoglobin (39.0 [31.5-74.5] vs 90.0 [57.0-122.0] mg/dL; P = .020), and higher LDH (271.0 [223.0-304.5] vs 186.0 [168.0-209.0] IU/L; P < .001) at baseline. All AKI events occurred in patients with the haptoglobin 2-2 phenotype, an exploratory finding. Procedural factors and postprocedural changes in hemolysis-related biomarkers did not differ between groups.

CONCLUSION

Baseline reduced estimated glomerular filtration rate, low haptoglobin, and elevated LDH were associated with postprocedural AKI, suggesting that patient vulnerability contributes to AKI after PFA.