Heart Rhythm. 2026 Mar 31:S1547-5271(26)02224-1. doi: 10.1016/j.hrthm.2026.03.1941. Online ahead of print.
ABSTRACT
BACKGROUND: Microsecond pulsed field ablation(microPFA) has been associated with post-ablation hemolysis, whereas evidence for the use of nanosecond PFA(nanoPFA) remains limited.
OBJECTIVE: This study aimed to compare hemolysis and acute kidney injury after microPFA, nanoPFA, and radiofrequency(RFA).
METHODS: We included 323 patients who underwent atrial fibrillation(AF) ablation at a high-volume Chinese center, including microPFA(n=186), nanoPFA(n=65), or RFA(n=72). Pulmonary vein isolation was performed with or without additional ablation. Hemolysis and renal biomarkers were measured at baseline, procedure end, and 24 hours post-procedure.
RESULTS: PFA produced obvious hemolysis, which was not observed with RFA. Postablation bilirubin, lactate dehydrogenase(LDH), and free hemoglobin increased and haptoglobin decreased with PFA. LDH (229.0±50.6 vs. 198.4±33.8 IU/L; P<0.001) and free hemoglobin (289.3 ± 45.1 vs. 263.7 ± 55.0 ng/mL; P=0.043) levels were higher with microPFA than with nanoPFA after multivariable adjustment. Hemoglobin decline and hemoglobin drop > 20g/L occurred more often after microPFA (44.1% and 58.1%) than after RFA (22.2% and 27.8%) and nanoPFA (18.5% and 20.0%). AKI was uncommon (microPFA 3, nanoPFA 1, RFA 0). In microPFA, hemolysis scaled with delivery number (LDH ratio r=0.26, 95% CI 0.10-0.40; bilirubin ratio r 0.15, 95% CI 0-0.29), whereas no dose-dependent association was detected with nanoPFA.
CONCLUSION: PFA for AF typically induced hemolysis; however, the application-related dose effect was observed in microPFA, but not in nanoPFA. NanoPFA was associated with lower hemolysis indices, while severe anemia and AKI may be rare. Larger studies are needed to confirm modality differences, define clinical impact, and optimize application titration.
PMID:41933637 | DOI:10.1016/j.hrthm.2026.03.1941