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. 2022 Apr 21;9(5):126.
doi: 10.3390/jcdd9050126.

Chronic Kidney Disease with Mild and Mild to Moderate Reduction in Renal Function and Long-Term Recurrences of Atrial Fibrillation after Pulmonary Vein Cryoballoon Ablation

Giuseppe Boriani  1 , Saverio Iacopino  2 , Giuseppe Arena  3 , Paolo Pieragnoli  4 , Roberto Verlato  5 , Massimiliano Manfrin  6 , Giulio Molon  7 , Giovanni Rovaris  8 , Antonio Curnis  9 , Giovanni Battista Perego  10 , Antonio Dello Russo  11 , Maurizio Landolina  12 , Marco Vitolo  1   13 , Claudio Tondo  14   15 , On Behalf Of The Stop ClinicalService Investigators
Affiliations

Chronic Kidney Disease with Mild and Mild to Moderate Reduction in Renal Function and Long-Term Recurrences of Atrial Fibrillation after Pulmonary Vein Cryoballoon Ablation

Giuseppe Boriani et al. J Cardiovasc Dev Dis. .

Abstract

The aim of this research was to evaluate if patients with chronic kidney disease (CKD) and mild or mild to moderate depression of renal function have an increased risk of atrial fibrillation (AF) recurrences after cryoballoon (CB) ablation. We performed a retrospective analysis of AF patients undergoing pulmonary vein isolation (PVI) by CB. The cohort was divided according to the KDIGO CKD-EPI classification into a (1) normal, (2) mildly decreased, or (3) mild to moderate reduction in estimated glomerular filtration rate (eGFR). Freedom from AF recurrences was the primary endpoint. A total of 1971 patients were included (60 ± 10 years, 29.0% females, 73.6% paroxysmal AF) in the study. Acute success and complication rates were 99.2% and 3.7%, respectively, with no significant differences among the three groups. After a follow-up of 24 months, AF recurrences were higher in the mildly and mild to moderate CKD groups compared to the normal kidney function group (23.4% vs. 28.3% vs. 33.5%, p < 0.05). Mild to moderate CKD was an independent predictor of AF recurrences after the blanking period (hazard ratio:1.38, 95% CI 1.02−1.86, p = 0.037). In conclusion, a multicenter analysis of AF patients treated with cryoablation revealed mild to moderate reductions in renal functions were associated with a higher risk of AF recurrences. Conversely, the procedural success and complication rates were similar in patients with normal, mildly reduced, or mild to moderate reduction in eGFR.

Keywords: atrial fibrillation; catheter ablation; chronic kidney disease; cryoablation; rhythm control.

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Conflict of interest statement

GB received small speaker’s fees from Medtronic, Boston, Biotronik, Boehringer, and Bayer, outside of the submitted work. RV received modest consultancy and speaker’s fees from Medtronic. GM received modest consultancy fees from Medtronic and Boston Scientific and speaker’s fees from Medtronic, Boston Scientific, St. Jude, and Boehringer Ingelheim. M.L. received modest consultancy fees from Boston Scientific, LivaNova, and Medtronic, CT serves as a member of Medtronic European Advisory Board and Boston Scientific International Advisory Board. He received lecture and proctor fees from Medtronic, Abbott Medical, Biosense Webster, and Boston Scientific. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curves. Freedom from AF recurrence according to kidney function. Legend: “Normal KF” = “Normal Kidney Function”; “Mild dec KF” = “Mildly decreased Kidney Function”; “Mild-Mod CKD” = “Mild to Moderate CKD”.
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