Pulsed field ablation-related hemoglobinuria and acute kidney injury: Insights and strategies for effective management

Abstract

Background: Pulsed field ablation has emerged as a novel technique for atrial fibrillation ablation, offering myocardial preferential ablation and safety advantages over traditional thermal energy methods. Complications such as hemolysis, hemoglobinuria, and acute kidney injury have been reported, particularly with high-energy delivery and excessive applications.

Objective: To understand the underlying mechanisms and potential preventative strategies, and identifying at-risk populations, to optimize procedural safety and ensure consistent outcomes.

Methods: This narrative review explores current data on mechanisms, incidence, clinical biomarkers, and risk factors that contribute to these issues.

Results: While transient and subclinical hemolysis is common, large scale registry data demonstrate that clinically significant hemolysis-induced renal complications remain rare, with fewer than 0.05% of patients requiring intervention. As catheter design and technology continue to evolve, further research with long-term data is crucial to continue to better understand and standardize mitigation strategies.

Conclusion: This paper provides an evidence-based framework and practical strategies, individual patient assessment, and postprocedural management to address and support safer integration of pulsed field ablation into clinical practice.