SynthesisOpen heart2025
Intravascular haemolysis following pulsed field ablation pulmonary vein isolation for atrial fibrillation: a systematic review.
Synthesis in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- 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
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPulsed field ablation (PFA) has emerged as a promising non-thermal alternative to conventional atrial fibrillation (AF) ablation techniques. However, intravascular haemolysis has been increasingly recognised as a potential complication, with variable incidence and clinical significance.
objectiveTo systematically review the available clinical evidence on PFA-related haemolysis, focusing on biochemical markers, clinical manifestations and device-specific differences.
methodsPubMed, Embase and Cochrane databases were searched until 20 May 2025 for clinical studies evaluating primarily PFA-pulmonary vein isolation for AF that reported haemolysis, acute kidney injury (AKI) or relevant biomarker changes. The primary outcome was evaluation of incidence and biochemical evidence of PFA-related haemolysis. Secondary outcomes included incidence of AKI and its clinical consequences.
results12 studies (≈20 000 patients) were included. Biomarker evidence of haemolysis was consistent, with postablation lactate dehydrogenase elevations of 250-438 U/L and bilirubin 15-48 µmol/L, often accompanied by reduced haptoglobin and elevated free haemoglobin. Incidence of haemolysis varied widely (0-94.3%), reflecting heterogeneity in definitions and reporting. Clinical sequelae were uncommon: haemoglobinuria was observed in five studies, and AKI occurred in 83 patients (0.4%), 12 requiring transient dialysis. All returned to baseline renal function except one patient with severe chronic kidney disease. Procedural factors and catheter design may influence haemolysis burden. Observations of lower haemolytic biomarker changes with devices such as PulseSelect, Affera and Volt are preliminary and require confirmation, given the predominance of Farawave data.
conclusionsHaemolysis is a reproducible biochemical outcome of PFA, but clinically significant events such as AKI are rare and usually reversible. Catheter design, energy delivery and patient baseline renal function are likely to modulate haemolysis risk. Standardised haemolysis definitions and prospective head-to-head comparisons across PFA platforms are needed to clarify clinical relevance and optimise safety. PROSPERO REGISTRATION NUMBER: CRD420251069612.
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