Intravascular Hemolysis and Acute Kidney Injury Associated with Pulsed Field Ablation vs. Thermal Ablation in Atrial Fibrillation: A Meta-Analysis
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Purpose To evaluate the comparative risk of hemolysis and acute kidney injury (AKI) after pulsed field ablation (PFA) vs. thermal ablation (TA) for atrial fibrillation (AF). 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 = 4,307) were included. PFA was not associated with higher AKI risk (RR 2.00, 95% CI 0.51–7.91) or creatinine change (MD 0.02 mg/dL, p = 0.10). LDH was higher (MD + 72 U/L p < 0.001) and haptoglobin lower (MD − 0.60 g/L p < 0.001) with PFA. Conclusions PFA causes greater biochemical hemolysis, but no significant renal injury compared with TA, supporting its favorable renal safety profile.
