Impact of renal function on intraprocedural anticoagulation during pulsed field versus radiofrequency ablation for atrial fibrillation
A Mpatsouli, S Xydonas, A Megarisiotou, G Papingiotis, S Ziogou, A TrikasAbstract
Background
The influence of renal function on activated clotting time (ACT) during different atrial fibrillation (AF) ablation modalities remains unclear.
Purpose
We sought to evaluate the relationship between glomerular filtration rate (GFR) and intraprocedural ACT dynamics between Pulsed Field ablation (PFA) and Radiofrequency (RF) ablation.
Methods
91 consecutive patients who underwent AF catheter ablation for paroxysmal or persistent AF were included in the study.All patients received uninterrupted Direct Oral Anticoagulant (DOAC) preoperatively and they were divided in distinct groups depending on whether they underwent PFA or RF ablation.In the PFA group ablation was performed via Affera™ and FARAPULSE™ PFA systems. In the RF group ablation was performed via THERMOCOOL SMARTTOUCH® SF Catheter.ACT levels were measured at 30 minutes after the onset of the procedure, during, and post-procedurally at standardized intervals.
Results
91 patients (PFA n=34, RF n=57) were included in the study.Mean GFR was similar between groups (PFA: 91.5±15.8 vs. RF: 89.7±16.9 mL/min/1.73m², p=0.68). Figure 1 demonstrates no significant correlation between GFR and baseline ACT for either method (r=-0.12, p=0.31), with parallel regression lines suggesting consistent method-specific differences across all GFR levels. PFA patients maintained higher baseline ACT (293±69s vs. 261±51s, p=0.043) independent of renal function. Figure 2 shows this difference persisted across GFR categories: in normal GFR (≥90), PFA achieved 298±72s versus RF 265±53s; in mild decrease (60-89), PFA showed 287±65s versus RF 256±48s (interaction p=0.42). Total heparin requirements were lower in PFA (10,014±2,436 vs. 14,933±4,597 IU, p<0.001) regardless of GFR category.
Conclusions
Renal function does not significantly influence baseline ACT or modify the differential ACT response between PFA and RF ablation, supporting current weight-based rather than GFR-adjusted heparin dosing protocols.