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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Catheter ablation for patients on hemodialysis with symptomatic atrial fibrillation

Lizhu Chen¹, Huikuan Gao¹, Tuo Liang¹

¹Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Annals of Palliative Medicine

|August 22, 2022

Insights

Catheter ablation (CA) for atrial fibrillation (AF) in hemodialysis (HD) patients shows potential efficacy and safety. While single ablation has higher recurrence, multiple ablations improve outcomes for these complex patients.

Area of Science:

Cardiology
Nephrology
Electrophysiology

Background:

Limited studies exist on catheter ablation (CA) for atrial fibrillation (AF) in patients undergoing intermittent hemodialysis (HD).
AF patients on HD have a higher incidence of AF and often poorly tolerate medical management due to renal failure.

Purpose of the Study:

To evaluate the efficacy and safety of CA for treating AF in patients on regular HD.
To compare AF recurrence and mortality rates between HD patients and a matched control group without renal impairment.

Main Methods:

Retrospective enrollment of 25 HD patients and 100 matched controls who underwent CA between March 2015 and January 2018.
Follow-up for up to 4 years post-first CA or 2.5 years post-second CA, monitoring AF recurrence, symptomatic AF, and all-cause mortality.

Main Results:

AF recurrence after a single CA was 56.0% in HD patients versus 77.0% in controls (P=0.021).
80.0% of HD patients remained free from symptomatic AF.
All-cause mortality was higher in the HD group (log-rank P=0.004), independent of AF recurrence.

Conclusions:

Catheter ablation is a potentially effective and safe treatment option for AF in patients on intermittent HD.
While single CA shows higher recurrence rates in HD patients, multiple ablations appear to enhance outcomes.

Read full analysis

Abstract

Background:

There are limited studies on the efficacy and safety of catheter ablation (CA) for patients with atrial fibrillation (AF) who receive intermittent hemodialysis (HD). This gap in the contemporary literature is notable as patients with AF receiving HD has higher incidence of AF and does not often tolerate medical management due to renal failure.

Methods:

From Mar 2015 and Jan 2018, 25 consecutive patients on regular HD from two cardiac centers who underwent CA were retrospectively enrolled. Another 100 patients without HD or renal impairment, matched by age, sex, and AF type, were enrolled from these cardiac centers as the control group. All patients were followed up at month 3, 6, and every 6 months after the first CAs for 4 years, and 2.5 years after a second CA (if applicable), unless endpoints were reached. The primary endpoint was AF recurrence after CA, and the secondary endpoints included symptomatic AF and all-cause mortality during the follow-up period.

Results:

AF patients receiving intermittent HD had a higher prevalence of hypertension (P=0.005), and heart failure (P=0.041). During the mean follow-up period of 37.6±17.4 months after the first CA, 14 out of the 25 HD patients (56.0%) remained free from AF recurrence, compared with 77 in the control patients (77.0%; P=0.021). Twenty (80.0%) patients in the HD group did not experience symptomatic AF. Second CAs were performed on 5 HD patients and 11 control patients, consequently 4 out of 5 (80.0%) HD patients and 7 out of 11 (63.6%) control patients had no AF recurrence (P=0.626) within 21.1±12.0 months after the second CA. Tamponade was the only procedural complication documented in both groups. All-cause mortality was higher in the HD group (log-rank P=0.004); however, the observed mortality was not related to AF recurrence.

Conclusions:

CA is a potential efficacious and safe treatment of AF for HD patients. The AF recurrence rate is higher after a single ablation compared with the general population, but multiple ablations seem to improve outcomes for HD patients.

Keywords:

Atrial fibrillation (AF)catheter ablation (CA)hemodialysis (HD)

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