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. 2023 Dec 28;26(1):euad371.
doi: 10.1093/europace/euad371.

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

Sandrine Venier  1 , Nathan Vaxelaire  1 , Peggy Jacon  1 , Adrien Carabelli  1 , Antoine Desbiolles  1 , Frederic Garban  2 , Pascal Defaye  1
Affiliations

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

Sandrine Venier et al. Europace. .

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.

Keywords: Acute kidney injury; Atrial fibrillation; Haemolysis; Pulsed field ablation.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Plasma creatinine levels before and after a PFA procedure for Patients 1 and 2. PFA, pulsed field ablation.
Figure 2
Figure 2
Correlation between biological parameters and the number of applications. (A) Leucocytes and the number of applications (R = 0.310, P = 0.016). (B) LDH and the number of applications (R = 0.601, P < 0.001). (C) Inverse correlation between haptoglobin and the number of applications (R = −0.411, P < 0.001). LDH, lactate dehydrogenase.
Figure 3
Figure 3
Correlation between the total number of applications and the biological parameters of renal function. (A) Correlation between the total number of applications and the creatinine level after ablation (R = 0.23, P = 0.18). (B) Correlation between the total number of applications and the urea level after the procedure (R = 0.32, P = 0.018).
Figure 4
Figure 4
Area under the curve (AUC), sensitivity, specificity, and optimal cut-off values for predicting a collapsed haptoglobin level (<0.04 g/L) on the first day after surgery by the number of applications. The ROC curve shows better sensitivity and specificity at around 70 applications (AUC: 0.709). ROC, receiver operating characteristic.
See this image and copyright information in PMC

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