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

Abstract

INTRODUCTION Data regarding catheter ablation of atrial fibrillation (AF) in patients with chronic kidney disease (CKD) is limited. We therefore assessed the association of CKD with common safety and clinical outcomes in a nationwide sample of ablation recipients. METHODS Using MarketScan® Commercial Claims and Medicare Supplemental Databases, we evaluated 30-day safety and 1-year clinical outcomes in patients who underwent a first AF ablation procedure between 2007–2011. We calculated frequency of common 30-day complications and calculated frequencies, incidence rates, and Cox proportional hazards for outcomes at 1 year post-ablation. RESULTS Of 21,091 patients included, 1,593 (7.6%) had CKD. Patients with CKD were older (64 vs 59 years, p<0.001) with higher CHA2DS2-VASc scores (3.2 vs 1.8, p<0.001). At 30 days post-ablation, patients with CKD had similar rates of stroke/TIA (0.13% vs 0.13%, p=0.99), perforation/tamponade (3.2% vs 3.1%, p=0.83), and vascular complications (2.4% vs 2.2%, p=0.59) as patients without CKD, but were more likely to be hospitalized for heart failure (2.1% vs. 0.4%, p<0.001). In multivariate analysis, there were no significant differences in hazards of AF hospitalization (adjusted HR: 1.02, 95%CI: 0.87–1.20), cardioversion (adjusted HR: 0.99, 95%CI: 0.87–1.12), or repeat AF ablation (adjusted HR: 0.89, 95%CI: 0.76–1.06) at one year. CONCLUSIONS Among patients selected for AF ablation, those with and without CKD had similar rates of post-procedural complications although they were more likely to be re-admitted for heart failure. CKD was not independently associated with AF hospitalization, cardioversion, and repeat ablation. These findings can inform clinical decision-making in patients with AF and CKD.

Urinary tract infection after catheter ablation of atrial fibrillation

“…We identified patient baseline comorbidities using documented ICD‐9 codes in the year preceding the index ablation using algorithms and methodology described in our previous work . The principal outcome of interest was UTI within 30 days of the index AF ablation, which was ascertained by searching across all inpatient and outpatient encounters for ICD‐9 code 599.0.…”

Chronic Kidney Disease and Arrhythmias: Conclusions From a Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference

“…The safety and efficacy of AF ablation in CKD was evaluated in 21 091 ablations, in which 1593 cases (7.6%) had CKD and 60 were on dialysis. 112 Among patients selected for AF ablation, those with and without CKD had similar rates of post-procedural complications and subsequent AF hospitalization, DCCV, and repeat ablation, although the patients with CKD were more likely to be re-admitted for heart failure. A meta-analysis of four studies of pulmonary vein isolation using radiofrequency ablation in patients with CKD showed a nearly two-fold increased risk of AF recurrence, possibly as a result of larger pre-ablation left atrial volumes, which may serve as a marker for non-pulmonary vein triggers of AF.…”

The effect of concomitant chronic kidney disease on the recurrence of atrial fibrillation after catheter ablation

“…[ 4 , 5 ] In addition, atrial fibrillation may accelerate the deterioration of renal function, which can be maintained or improved by maintaining sinus rhythm. [ 6 ]…”