Observational studyEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
Incidence of laboratory-defined severe intravascular haemolysis across commercially available pulsed field ablation technologies for atrial fibrillation.
Observational study in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
What it found
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Practical guide on the use of the PulseSelect pulsed field ablation system for atrial fibrillation ablation procedures.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Guideline
- Pulsed field ablation for the interventional treatment of atrial fibrillation: a scientific statement of the European Heart Rhythm Association of the European Society of Cardiology, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, the Latin American Heart Rhythm Society, and the Canadian Heart Rhythm Society.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Guideline
- Evaluation of Hemolysis Risk, Renal Function, and Safety Among Two Pulsed Field Ablation Systems: A Systematic Review and Meta-Analysis.Journal of arrhythmia · 2026Review
- Haemolysis and renal effects across pulsed field ablation systems in atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Pulsed Field Ablation for Atrial Fibrillation: Mechanism, Clinical Evidence, and Emerging Applications.Cureus · 2026Review
- Influence of dielectric perfusate on pulsed-field ablation-induced haemolysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Delayed coronary vasospasm after pulsed field ablation for pulmonary vein isolation despite avoidance of coronary-adjacent ablation sites.HeartRhythm case reports · 2026Article
- Pulsed field ablation: from technological breakthrough to structured clinical implementation-the role of the European Heart Rhythm Association.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Evaluation of the risk of hemolysis using the circular array pulsed field ablation catheter in the management of atrial fibrillation.Heart rhythm O2 · 2026Article
- Biochemical evidence and clinical significance of hemolysis following catheter ablation with a lattice-tip PFA catheter.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsRenal failure due to intravascular haemolysis (IH) has been reported after pulsed field ablation (PFA) of atrial fibrillation (AF). However, IH incidence using the accepted laboratory criteria is unknown. METHODS AND
resultsIn this prospective observational study (Sept 2024-May 2025), consecutive patients undergoing PFA for AF with pentaspline (PS), circular array (CA), or lattice tip (LT) catheters were included. Pre- and post-procedural labs and haemolysis biomarkers were collected. Significant IH was defined as post-procedure free plasma haemoglobin > 100 mg/dL per haematology criteria. Logistic regression (pooled and stratified) was used to identify IH predictors. Among 245 patients (66.9 ± 10.6 years; 68.2% male; 48.2% persistent), PFA was performed using the LT (62), PS (108), or CA (75) catheters. There was a significant difference in the incidence of IH across technologies (37.0%, 26.1%, and 14.7% for PS, CA, and LT, P = 0.002). No demographic or clinical parameters were associated with higher IH risk, while the use of PS was the only independent predictor [odds ratio (OR) 3.42, P = 0.001] of IH. The number of PF lesions increased risk for IH only within the PS group (OR 1.03, P = 0.049). Routine post-ablation laboratories had poor sensitivity/specificity to define severe IH.
conclusionAlthough over 17% of the cohort met the haematologic definition for significant IH, the absence of clinically significant renal impairment suggests that this threshold may not accurately reflect clinically meaningful haemolysis following PFA. The absence of clinical predictors or laboratory surrogates suggests that the rare risk of renal injury must be balanced with the well-established benefits of PFA when lesions are delivered in moderation optimizing tissue contact.
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