Acute kidney injury and haptoglobin depletion after pulsed field ablation: Impact of device type under routine hydration protocol

Yosuke Hayashi; Shinsuke Miyazaki; So Asano; Yukio Sekiguchi; Junichi Nitta; Tetsuo Sasano

doi:10.1016/j.hrthm.2025.12.009

Acute kidney injury and haptoglobin depletion after pulsed field ablation: Impact of device type under routine hydration protocol

Heart Rhythm. 2025 Dec 8:S1547-5271(25)03143-1. doi: 10.1016/j.hrthm.2025.12.009. Online ahead of print.

Authors

Yosuke Hayashi¹, Shinsuke Miyazaki², So Asano³, Yukio Sekiguchi³, Junichi Nitta³, Tetsuo Sasano²

Affiliations

¹ Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan; Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan. Electronic address: ysk.hayashi1988@gmail.com.
² Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan.
³ Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.

PMID: 41371531
DOI: 10.1016/j.hrthm.2025.12.009

Abstract

Background: Hemolysis can occur after pulsed field ablation (PFA) and cause acute kidney injury (AKI).

Objectives: This study aimed to identify the risk factors for severe hemolysis, defined as haptoglobin depletion, and AKI after PFA for atrial fibrillation (AF).

Methods: Consecutive patients who underwent postoperative blood testing to assess renal function and hemolysis after AF ablation using 2 different PFA systems were included. All patients received 1500 mL of perioperative intravenous saline. Haptoglobin depletion was defined as levels below the assay's lower detection limit for the phenotype.

Results: A total of 211 patients (68 years; 69% male; 58% paroxysmal AF; Farapulse: n = 117; PulseSelect: n = 94) were included. The total PFA application number was 56 (44-62) and 43 (39-48) in the Farapulse and PulseSelect groups, respectively. Haptoglobin depletion and AKI occurred in 56 (27%) and 13 (6%) patients. One patient was rehospitalized, and 5 had prolonged stays owing to AKI. AKI was significantly more frequent in patients with higher body mass index (26.5 ± 4.7 vs 23.8 ± 3.7 kg/m², P = .014) and lower baseline estimated glomerular filtration rate (50.9 ± 14.8 vs 63.0 ± 12.6 mL/min per 1.73 m², P < .01). In multivariate analysis, Farapulse use (odds ratio, 3.33; 95% confidence interval, 1.56-7.10; P < .01) and absence of diabetes mellitus (odds ratio, 3.59; 95% confidence interval, 1.170-11.100; P = .026) were significantly associated with haptoglobin depletion. No significant association was observed among postoperative AKI and haptoglobin depletion, type of PFA system, or total application numbers.

Conclusions: Under routine perioperative fluid administration, lower renal function and higher body mass index were associated with postoperative AKI, whereas Farapulse use and absence of diabetes mellitus were associated with severe hemolysis.

Keywords: Acute kidney injury; Atrial fibrillation; Haptoglobin depletion; Hemolysis; Pulsed field ablation.