Impact of Pulse Field Ablation on Hemolysis Markers: A Single-Center Experience

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Heart Rhythm

Abstract

Background: Pulse field ablation (PFA) is increasingly used for ablation of atrial fibrillation (AF) due to its favorable safety profile. Yet, the factors driving PFA-related hemolysis and its potential renal impact are not well defined. Objective: To describe the change in hemolysis markers with PFA and identify factors associated with postprocedural hemolysis. Methods: We performed a retrospective cohort study of patients with AF who received PFA at our health system (June 2024- May 2025). Postprocedural hemolysis was assessed using plasma-free hemoglobin (Hb) levels, with patients stratified into high (.30 mg/dL) and normal/low (≤30 mg/dL) groups. Baseline characteristics, procedural details, and renal outcomes were compared between groups, and multivariable analyses were conducted to identify independent risk factors associated with hemolysis. Results: A total of 232 patients (FARAPULSE [Manufacturer 1 PFA system] in 173 patients [74.6%]; PulseSelect [Manufacturer 2 system] in 59 patients [25.4%]) underwent PFA (mean age 67.5 6 9.6, 37.9% female), of whom 109 (47.0%) developed high postprocedural plasma-free Hb (.30 mg/dL). Baseline demographics were similar between groups, but patients with high free Hb were more often treated with the Manufacturer 1 PFA system (91.7% vs. 59.3%, P,0.01), underwent PVI with additional ablation (73.4% vs. 46.3%, P,0.01), and received a greater number of applications (63.2 6 14.9 vs. 51.1 6 11.5, P,0.01). On multivariable analysis, independent risk factors associated with hemolysis included use of the Manufacturer 1 system (aOR 6.67, 95% CI 2.94–16.47), total applications .59 (aOR 4.25, 95% CI 2.04–9.19), and higher preprocedural hemoglobin level (aOR 1.52, 95% CI 1.19–1.97). The rate of AKI was low and similar between the two groups (0.9% vs. 0.8%, P51.00). None of the patients required renal replacement therapy. Conclusion: Our real-world study, following the commercial approval of PFA systems, showed that 47% of patients developed subclinical hemolysis after PFA, with no actionable clinical outcomes.

Volume

23

Issue

4 Suppl

First Page

S239

Comments

Heart Rhythm Society Annual Meeting, April 23-26, 2026, Chicago, IL

Last Page

S239

DOI

10.1016/j.hrthm.2026.03.1658

Link to Full Text

Share

COinS