Auf der Heiden Carsten, Bejinariu Alexandru Gabriel, Kelm Malte, Spieker Maximilian, Rana Obaida
Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
Department of Cardiology, Pulmonary Diseases and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
Heart Rhythm. 2025 Apr 23. doi: 10.1016/j.hrthm.2025.04.038.
Intravascular hemolysis with consecutive acute kidney injury (AKI) has been described after pulsed-field ablation (PFA) in atrial fibrillation (AF).
This study aimed to evaluate the risk of intravascular hemolysis and AKI after PFA with different numbers and forms of applications.
From May 2022 to August 2024, consecutive patients undergoing AF ablation were prospectively enrolled in 4 groups, including equally distributed numbers of patients undergoing PFA (pentaspline catheter) with 8 applications per vein (PFA-8), with 16 applications per vein (PFA-16), CardioFocus focal PFA, and radiofrequency ablation (RFA). Blood samples were collected immediately before and after the ablation, and on the following day to analyze hemolysis markers and indicators for AKI.
A total of 200 patients (68.4 ± 10.8 years) could be included in the final analysis. The blood samples revealed a significant increase in total bilirubin and lactate dehydrogenase across all PFA modalities and RFA 24 hours after ablation compared with baseline levels. Potassium levels increased significantly in all PFA modalities immediately post-ablation as compared with baseline, followed by a return to approximately baseline after 24 hours. No significant potassium fluctuations were observed in RFA. Serum creatinine levels showed no significant increase in any PFA modality or RFA within the 24-hour assessment period.
PFA using a multispline catheter with 8 and 16 applications per PV and focal PFA using CardioFocus (CardioFocus Inc., Massachusetts) platform showed no safety concerns with respect to hemolysis-induced AKI.
心房颤动（AF）患者在接受脉冲场消融（PFA）后出现了血管内溶血并伴有连续性急性肾损伤（AKI）。
本研究旨在评估不同应用次数和形式的PFA后血管内溶血和AKI的风险。
从2022年5月至2024年8月，连续接受AF消融的患者被前瞻性纳入4组，包括每组患者数量均等，分别接受每条静脉8次应用（PFA-8）、每条静脉16次应用（PFA-16）的多极导管PFA、CardioFocus局灶性PFA以及射频消融（RFA）的患者。在消融前、消融后即刻以及次日采集血样，以分析溶血标志物和AKI指标。
最终分析共纳入200例患者（68.4±10.8岁）。血样显示，与基线水平相比，所有PFA方式和RFA在消融后24小时总胆红素和乳酸脱氢酶显著升高。与基线相比，所有PFA方式在消融后即刻血钾水平显著升高，随后在24小时后恢复至大致基线水平。RFA未观察到明显的血钾波动。在24小时评估期内，任何PFA方式或RFA的血清肌酐水平均未显著升高。
使用每条肺静脉8次和16次应用的多极导管PFA以及使用CardioFocus（马萨诸塞州CardioFocus公司）平台的局灶性PFA在溶血诱导的AKI方面未显示出安全问题。
