Multicenter Experience of Catheter Ablation for Atrial Fibrillation in Sickle Cell Anemia

Adult patients with sickle cell anemia (SCA) are at high risk for atrial arrhythmias; however, data on the outcomes of atrial fibrillation (AF) ablation in this population are scarce.

Eight consecutive SCA patients undergoing AF ablation in three tertiary ablation centers were retrospectively included (6 males, mean age 46 ± 9 years). Patients exhibited severe left atrial (LA) remodeling (mean indexed LA volume 71 ± 14 mL/m²) and six presented with persistent AF. Ablation techniques included radiofrequency (RF, n = 6), cryoballoon (n = 1), and pulsed-field ablation (PFA, n = 1). Three patients received additional LA lesions beyond pulmonary vein isolation. At 12 months, seven patients (88%) were free from any atrial arrhythmia, with 88% off antiarrhythmic therapy, and NYHA class significantly improved from 2.00 ± 0.93 to 1.38 ± 0.52 (p = 0.049). No major complications were reported following RF ablations. The cryoballoon case was complicated by an acute chest syndrome, while moderate hemolysis occurred following PFA, without clinical consequence.

AF catheter ablation appears effective in SCA patients. While RF ablation showed a reassuring safety profile, specific risks associated with cryoballoon and PFA warrant further investigation.