Chronic Kidney Disease Should Not Exclude Patients with Low Atrial Fibrosis from Catheter Ablation Therapy for Atrial Fibrillation

2014 ◽  
Vol 25 (12) ◽  
pp. E8-E8
Author(s):  
NAZEM AKOUM ◽  
LEENHAPONG NAVARAVONG ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Atrial Fibrosis ◽  
Ablation Therapy

MO749CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ON DIALYSIS - A META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Isaac Chung ◽  
Yasir Khan ◽  
Rao Kondapally ◽  
Manav Sohal ◽  
Debasish Banerjee
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Recurrence Rates ◽  
Ablation Therapy ◽  
Abnormal Metabolism ◽  
Af Recurrence

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.

scholarly journals Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease

2016 ◽  
Vol 28 (1) ◽  
pp. 39-48 ◽  
Author(s):  
ADITYA J. ULLAL ◽  
DANIEL W. KAISER ◽  
JUN FAN ◽  
SUSAN K. SCHMITT ◽  
CLAIRE T. THAN ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Clinical Outcomes

Concomitant chronic kidney disease increases the recurrence of atrial fibrillation after catheter ablation of atrial fibrillation: A mid-term follow-up

Heart Rhythm ◽  
2011 ◽  
Vol 8 (3) ◽  
pp. 335-341 ◽  
Author(s):  
Yoshihisa Naruse ◽  
Hiroshi Tada ◽  
Yukio Sekiguchi ◽  
Takeshi Machino ◽  
Mahito Ozawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease

Long-Term Follow-Up after Catheter Ablation of Paroxysmal Atrial Fibrillation in Patients with Chronic Kidney Disease Undergoing Hemodialysis

2011 ◽  
Vol 27 (Supplement) ◽  
pp. OP23_4
Author(s):  
Keiichi Hishikari ◽  
Hiroshi Taniguchi ◽  
Shigeki Kusa ◽  
Kei Takayama ◽  
Takashi Uchiyama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Paroxysmal Atrial Fibrillation ◽  
Long Term Follow Up

Meta-analysis of Clinical Outcomes of Electrical Cardioversion and Catheter Ablation in Patients with Atrial Fibrillation and Chronic Kidney Disease

2018 ◽  
Vol 24 (24) ◽  
pp. 2794-2801 ◽  
Author(s):  
Igor Diemberger ◽  
Simonetta Genovesi ◽  
Giulia Massaro ◽  
Maria Letizia Bacchi Reggiani ◽  
Jessica Frisoni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Electrical Cardioversion ◽  
Cochrane Central Register ◽  
Pharmacological Management ◽  
Increased Risk

Background: Chronic kidney disease (CKD) is associated with adverse outcomes in presence of atrial fibrillation (AF). However, the literature shows limited data on non-pharmacological management of AF in CKD patients. Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials and performed a metaanalysis. The primary outcome was recurrence of AF. The secondary outcomes were occurrence of thromboembolic events (TEs) and estimated glomerular filtration rate (eGFR) modification. Results: Literature search yielded 26 eligible papers: 22 on CA and 4 concerning ECV. CKD patients presented more AF recurrences 30 days after ECV (OR 2.62, 95%CI 1.28-5.34; p <0.001). Patients with eGFR<60-68 ml/min and on dialysis presented a higher incidence of AF recurrences after CA, median follow up 26.0 and 29.9 months (HR 1.75, 95%CI 1.46-2.09, p <0.001; and HR 1.69, 95%CI 1.22-2.33, p <0.001; respectively). Periprocedural TEs were rare and not associated with CKD or dialysis. However, patients with CKD were at increased risk for delayed TEs after CA (HR 2.61, 95%CI 1.04-6.54; p <0.001). No significant modification of eGFR was associated with ECV or CA in the overall population. Conclusion: ECV and CA for sinus rhythm restoration/maintenance in AF patients, albeit theoretically promising, seem to be associated with lower efficacy at medium to long-term in patients with CKD. Further studies are needed to better define the role of ECV and CA in CKD.

P11 The difference in the serial change of indoxyl sulfate after catheter ablation among atrial fibrillation patients with or without chronic kidney disease

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
H Koike ◽  
I Watanabe ◽  
KATSUYA Akitsu ◽  
MASAYA Shinohara ◽  
TOSHIO Kinoshita ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Indoxyl Sulfate ◽  
Uremic Toxin ◽  
Ckd Stage ◽  
Serial Change ◽  
The Difference

Abstract Introduction It is well known that catheter ablation (CA) for patients with atrial fibrillation (AF) improves their renal function. However, the precise mechanism of improving a renal function, such as a transition of the uremic toxin is unclear. Purpose Indoxyl sulfate (IS), a protein-bound uremic toxin, induces chronic kidney disease (CKD) and AF. This study aimed to investigate the transition of serum IS level in the AF patients with and without CKD after CA. Methods A total of 138 consecutive AF patients who underwent CA and maintained sinus rhythm were prospectively enrolled (age 65.5 ± 10.7 years, paroxysmal AF 67.4%). Patients were divided into 4 groups (non-CKD/low-IS:68, non-CKD/high-IS:28, CKD/low-IS:13, CKD/high-IS:29). CKD was defined as CKD stage III (estimated glomerular filtration rate (eGFR) 30-60 ml/min/1.73m2), and high-IS was defined according to the mean of IS (IS≥1.1 μg/ml) before CA. Plasma IS levels and eGFR were determined before and at 1 year after CA. We evaluated the relationship between the IS and eGFR after CA among the 4 groups. Results CA significantly improved the eGFR in patients with CKD (from 50.2 ± 5.7 to 55.4 ± 10.8 ml/min/1.73m2, p &lt; 0.001). The serum IS level in the patients with non-CKD/high-IS was significantly decreased (from 1.7 ± 0.7 to 1.1 ± 0.6 μg/ml, p &lt; 0.001). However, the serum IS level in the patients with CKD/high-IS was not improved (from 1.9 ± 0.9 to 1.7 ± 0.7 μg/ml, p = 0.22) and significantly higher than that in the others (p &lt; 0.001), regardless of improving their eGFR (Figure). Furthermore, the multiple regression analysis revealed that the ΔIS, between before and after CA, was independent of eGFR. Conclusion The change of IS in the patients with CKD was significantly different from that in those without CKD. In the patients with CKD, CA improved their eGFR, however, the serum level of IS, a protein-bound uremic toxin, was not improved after CA. Abstract P11 Figure. Serial Change of eGFR and IS

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