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

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.

Clinical Outcomes of Intracardiac Echocardiography-Guided Contrast Agent-Free Cryoballoon Ablation in Atrial Fibrillation Patients With Renal Insufficiency

“…Yanagisawa et al 14) reported that a low estimated glomerular filtration rate at baseline was an independent predictor of recurrence after CBA in patients with PAF. Boriani et al 15) revealed that mild-to-moderate reductions in renal function was associated with a higher risk of AF recurrence after CBA. These results contradict the findings of the present study.…”

“…A few reports have described the influence of impaired renal function on clinical outcomes in AF patients who underwent CBA. 14) 15) 16) However, the changes in renal function following CBA have not been fully elucidated. Thus, the purpose of this study was to compare the efficacy and safety of CBA in AF patients with CKD versus those without CKD and to evaluate the changes in renal function over 12 months after CBA in AF patients.…”

Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias

“…In most studies, predictors for these overall complications were coronary artery disease and peripheral artery disease, as well as age > 50 years, chronic kidney disease, hypertension and female gender [11,26,27]. Additionally, an analysis of the Nationwide Inpatient Sample (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) shows that obesity is an independent risk factor for immediate postablation complications and higher costs for patients undergoing catheter ablation for atrial fibrillation [28,29].…”

New Perspectives on Risk Stratification and Treatment in Patients with Atrial Fibrillation: An Analysis of Recent Contributions on the Journal of Cardiovascular Disease and Development

“…Patient comorbidities are a crucial aspect of ablation success, also in terms of clinical outcomes. A multicenter analysis of AF patients treated with cryoablation found that patients with chronic kidney disease, even with mild to moderate reduction in renal function, were associated with a higher risk of AF recurrences [ 60 ]. Conversely, the procedural success and complication rates were similar in patients with normal, mildly reduced, or mild to moderate reduction in glomerular filtration rate [ 60 ].…”

“…A multicenter analysis of AF patients treated with cryoablation found that patients with chronic kidney disease, even with mild to moderate reduction in renal function, were associated with a higher risk of AF recurrences [ 60 ]. Conversely, the procedural success and complication rates were similar in patients with normal, mildly reduced, or mild to moderate reduction in glomerular filtration rate [ 60 ]. A case-control study showed that obese patients did not have higher AF recurrence rates after CA compared to patients with normal body weight, suggesting that body mass index alone may not be a criterion for refusing catheter ablation [ 61 ].…”