Outcomes of atrial fibrillation ablation in patients with chronic kidney disease

Limited and inconsistent data exist regarding the impact of kidney function on outcomes following ablation procedures in patients with atrial fibrillation (AF). This study aimed to evaluate the effectiveness and safety of AF ablation in a large national cohort stratified by levels of estimated glomerular filtration rates (eGFR).

The Israeli Catheter Ablation Registry (ICAR) is a prospective, multicenter cohort study of patients who underwent pulmonary vein isolation (PVI) for AF treatment between 2019 and 2021. The primary study endpoints were AF recurrence and the need for repeat ablation at 12 months. Secondary endpoints included rehospitalization and procedural complications.

Between January 2019 and December 2021, 925 AF patients underwent PVI. Baseline creatinine data were available for 856 patients, forming the study cohort. Among these, 211 patients (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 (<59 mL/min/1.73m²), classified as chronic kidney disease (CKD). Baseline characteristics are summarized in Table 1. Patients with lower eGFR were older, less frequently women, and more likely to have cardiovascular risk factors and a history of cardiovascular disease. Median AF duration was three years across all groups, with persistent AF significantly more common in patients with lower eGFR. Most patients (87%) underwent cryoablation, 5% underwent radiofrequency (RF) ablation, and 7% received both cryo and RF ablation. No significant procedural differences were observed between groups (Table 2). Of the 856 patients, 25 had no 12-month follow-up data, and 19 were lost to follow-up. Among the remaining 812 patients, there were 8 deaths (1 cardiac, 6 non-cardiac, and 1 of unknown cause); two of the deceased provided usable data, and five patients withdrew consent, resulting in outcome data for 801 patients, Table 3. Twelve-month AF recurrence rates did not differ significantly among the groups: 16%, 20%, and 20% in patients with preserved, mild, and moderate-severely reduced eGFR/CKD, respectively (p=0.3). However, the one-year rehospitalization rate was higher in those with moderate to severely reduced eGFR: 13%, 17%, and 25% for preserved, mild, and moderate-severely reduced eGFR/CKD, respectively (p=0.005, Table 4).

Pulmonary Vein Isolation is a safe and effective treatment for Atrial Fibrillation in patients with Chronic Kidney Disease and should be considered for all suitable CKD patients, regardless of kidney function.

Graph and tables