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

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.