Outcomes of Atrial Fibrillation Ablation in Patients with Chronic Kidney Disease

Background: Limited and inconsistent information exist about how kidney function affects the outcomes of ablation procedures in patients with atrial fibrillation (AF). Therefore, the aim of this study was to investigate the effectiveness and safety of AF ablation in a large national study across groups classified by varying levels of estimated glomerular filtration rates (eGFR).

Methods: The Israeli Catheter Ablation Registry (ICAR) is a prospective, multicenter cohort that includes patients who underwent pulmonary vein isolation (PVI) during the years 2019-2021 for the treatment of AF. Primary study endpoints were the recurrence of AF and the need for repeat ablation at 12 months. Secondary endpoints were rehospitalization and procedural complications after AF ablation.

Results: Between January 2019 and December 2021, 925 AF patients underwent PVI. Baseline creatinine was available in 856 patients, which comprised the study cohort. Of these patients, 211 (24.6%) had preserved eGFR (>90 mL/min/1.73m2), 466 (54.4%) had mildly reduced eGFR (60-89 mL/min/1.73m2) and 179 (21%) had moderate to severely reduced eGFR (<59mL/min/1.73m2) i.e. chronic kidney disease (CKD). There were no significant differences in 12-month AF recurrence rates between the 3 study groups: 16%, 20% and 20% in patients with preserved eGFR, mild, and moderate-severely reduced eGFR/ CKD, respectively (p=0.3). The one-year rehospitalization rate was higher in patients with moderate to severely reduced eGFR (13%, 17% and 25% in patients with preserved eGFR, mild, and moderate to severely reduceds eGFR/CKD, respectively (p=0.005).

Conclusions: PVI is an effective and a safe treatment for patients with AF and CKD, and it should be considered in all CKD patients who are suitable for the procedure, irrespective of their state of kidney function.