Catheter Ablation for Atrial Fibrillation in Patients with Chronic Kidney Disease and on Dialysis: A Meta-Analysis and Review

Abstract

Background: Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with anti-arrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation, if successful, may be a safer alternative. This review aimed to analyse the effect of CKD or haemodialysis (HD) on recurrence of AF after catheter ablation.

Methods: MEDLINE, Embase, and PubMed databases were searched until December 2020. Two authors abstracted the data independently. Relative risks were derived using random-effects meta-analysis.

Results: Of the initially identified 782 studies, 6 and 4 observational studies investigating CKD and HD patients, respectively reported AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients demonstrated a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI: 1.36-4.02, p < 0.01). The heterogenicity test highlighted significant differences between individual studies (I2 = 91.0%, 95% CI: 82.2-95.6%). In a mean (SD) follow-up of 32.6 (26.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.50, 95% CI: 0.84-2.67, p = 0.17). Heterogeneity analysis showed the studies were heterogeneous (I2 = 90.1%, 95% CI: 77.5-95.6%, p < 0.01).

Conclusion: Our meta-analysis suggests patients with CKD and on HD are more likely to have AF recurrences compared to AF patients who do not have CKD. However, more robust evidence from randomized controlled trials comparing catheter ablation to pharmaceutical rhythm therapy is urgently needed to guide therapy in this difficult to treat population.

Keywords: Atrial fibrillation; Catheter ablation; Chronic kidney disease; Dialysis.