Pulsed-field ablation shows no significant AKI difference versus radiofrequency ablation in AFPulsed-field ablation shows similar kidney risk as radiofrequency ablation

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing Published June 1, 2026 Study authors: Barbosa Gabriel Alves, Osmancik Pavel, Santos Charles Karel Martins, Miranda Maria Clara Ramos, Barb… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider that PFA may carry a slightly higher AKI risk than RFA, but heterogeneity limits certainty.

This systematic review and meta-analysis evaluated the risk of acute kidney injury (AKI) and renal function in patients undergoing pulsed-field ablation (PFA) versus radiofrequency ablation (RFA) for atrial fibrillation. The analysis included 3,843 patients (1,859 in the PFA group and 1,994 in the RFA group). The primary outcome showed no significant differences in AKI and renal function between the two groups, with a total AKI prevalence of 2.1% (95% CI [0.90; 4.84]) in the PFA group.

However, a leave-one-out analysis excluding one outlier study revealed a statistically significant increased risk of AKI with PFA (OR 3.70; 95% CI [2.49; 5.51]; p = 0.0019). Additionally, all evaluated hemolysis biomarkers were significantly elevated in the PFA group, although with high heterogeneity.

The authors note substantial heterogeneity (I > 25%) as a limitation, and the follow-up duration was not reported. The review suggests that PFA may be associated with a slightly higher risk of AKI than RFA, but the evidence is not definitive.

Clinicians should consider these findings when choosing ablation modalities, but the results should be interpreted cautiously due to the heterogeneity and the sensitivity of the leave-one-out analysis.

A major review compared two ways to treat atrial fibrillation: pulsed-field ablation (PFA) and radiofrequency ablation (RFA). The main goal was to see if one method caused more kidney injury than the other. The review looked at data from over 3,800 patients.

The main finding was that there was no significant difference in the overall risk of kidney injury between the two treatments. The total rate of kidney problems was about 2% for patients getting PFA. This means both procedures appear similarly safe for the kidneys in general.

However, when researchers did a special analysis that removed one study with unusual results, they found a higher risk of kidney injury with PFA. This suggests that while the overall risk is similar, there might be a small increased chance in some situations. The review also found that markers of blood cell damage were higher in the PFA group.

The study had some limitations, including differences between the included studies. More research is needed to confirm these findings and understand the small risk difference. Patients should discuss these options with their doctor to decide the best treatment for their situation.

What this means for you:

Both heart rhythm treatments have similar kidney risks, but PFA may slightly increase risk in some cases.

Study Details

Study typeMeta analysis

Sample sizen = 3,843

EvidenceLevel 1

PublishedJun 2026

PMID41359232

View Original Abstract ↓

BACKGROUND: Pulsed-field ablation (PFA) has emerged as a potentially safer alternative to radiofrequency ablation (RFA). However, recent studies have raised concerns that PFA may induce hemolysis, which could contribute to the development of acute kidney injury (AKI). METHODS: The PubMed, Embase, Scopus, and Cochrane databases were searched for randomized clinical trials (RCTs) and non-RCTs that reported AKI incidence and hemolysis biomarkers after PFA. Random-effects models were used to calculate pooled odds ratio (OR) and mean differences (MDs) with 95% confidence intervals (CIs). Substantial heterogeneity was defined as I > 25%. RESULTS: Ten studies, including one RCT, comprising a total of 3,843 patients, were included, with 1,859 in the PFA group and 1,994 in the RFA group. In the primary endpoint analysis related to AKI and renal function, no significant differences were found between the PFA and RFA groups, with PFA having a total prevalence of 2.1% (95% CI [0.90; 4.84]). The leave-one-out analysis, specifically the exclusion of one outlier study, led to the comparative results having statistical significance statistical significance (OR 3.70, 95% CI [2.49; 5.51], p = 0.0019; I² = 0%), indicating no heterogeneity, and with the total prevalence increasing to 2.4% (95% CI [0.96; 5.93]). Regarding hemolysis, all evaluated biomarkers were significantly elevated in the PFA group, although with high heterogeneity. CONCLUSION: PFA appears to be associated with a slightly higher risk of AKI than RFA. Renal injury is mostly mild-degree and transient. PFA is associated with significant peri-procedural hemolysis.

Pulsed-field ablation shows no significant AKI difference versus radiofrequency ablation in AFPulsed-field ablation shows similar kidney risk as radiofrequency ablation

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Pulsed-field ablation shows no significant AKI difference versus radiofrequency ablation in AFPulsed-field ablation shows similar kidney risk as radiofrequency ablation

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