Abstract
Background and Aims
Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with antiarrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation if successful may be a safer alternative. This review evaluates the efficacy of catheter ablation therapy in CKD and haemodialysis (HD) patients.
Method
MEDLINE and Embase databases were searched with the following search terms: “(atrial fibrillation AND (chronic kidney disease OR renal failure OR renal function OR dialysis) AND ablation)” for journal articles of any language until December 2020. Two authors abstracted the data independently. Risk ratios were derived using random-effects meta-analysis.
Results
Of the initially identified 520 studies, 5 and 3 observational studies on CKD and HD patients respectively were found reporting AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients had a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI 1.36-4.02, p<0.01). The heterogenicity test showed there were significant differences between individual studies (I2 = 91%, 95% CI 82.2%-95.6%, p<0.01). In a mean (SD) follow-up of 40.3 (20.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.21, 95% CI 0.64-2.30, p=0.55). Heterogeneity analysis showed the studies were heterogeneous (I2 92.3%, 95% CI 80.8%-96.9%, p <0.01).
Conclusion
Our meta-analysis suggests patients with CKD and patients on HD are more likely to have AF recurrences after catheter ablation compared to AF patients who are otherwise healthy. However, more robust evidence from randomized controlled trials comparing catheter ablation and pharmaceutical rhythm therapy are urgently needed to guide therapy in this difficult to treat population.
OUTCOMES OF THE HYBRID VIDEO-ASSISTED THORACOSCOPIC SURGERY (VATS) MAZE FOLLOWED BY CATHETER ABLATION IN PATIENTS WITH PERSISTENT AND LONGSTANDING PERSISTENT ATRIAL FIBRILLATION: CLINICAL RESULTS FROM A HIGH-VOLUME CENTER
