Stage 3 Acute Kidney Injury Secondary to Haemolysis After High-Burden Pulsed Field Ablation in a Patient With Normal Baseline Renal Function: A Case Report

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ID: 337988
2026
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Abstract
Structured Abstract Background Pulsed field ablation (PFA) causes intravascular haemolysis via irreversible electroporation of erythrocytes. Clinically significant acute kidney injury (AKI) has been reported predominantly in patients with pre-existing chronic kidney disease. However, the relationship between pulse burden and haemolysis-induced renal injury in patients with normal baseline renal function remains incompletely characterised. Case Summary A 76-year-old woman with persistent atrial fibrillation and normal baseline renal function (creatinine 89 µmol/L [normal: 44–80 µmol/L]; eGFR >60 mL/min/1.73m2) underwent high-burden PFA (72 pulses; Farawave™, Boston Scientific) over a 75-minute procedure including all four pulmonary veins, left atrial roof, and posterior wall. Within 48 hours she developed haemoglobinuria, haemoglobin fall from 132 to 83 g/L (normal: 120–160 g/L), LDH 597 U/L (normal: 135–214 U/L), and undetectable haptoglobin (normal: 0.3–2.0 g/L). Creatinine peaked at 720 µmol/L (KDIGO Stage 3 AKI). Serial LDH declined to 304 U/L by day 8 of admission, consistent with haemolytic resolution. No intraoperative contrast was used; alternative contributors to AKI including contrast nephropathy and nephrotoxic medications were excluded. Full renal recovery was achieved with intravenous hydration and urinary alkalinisation (discharge creatinine 112 µmol/L, day 17).
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Authors Hassan Ali Alzahrani, Yahya Allush, Mohsen Jaber Yahya Alotayfi, Ahmed R. Al Fagih
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag813
URL
https://doi.org/10.1093/ehjcr/ytag813
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