Meta-analysis of Clinical Outcomes of Electrical Cardioversion and Catheter Ablation in Patients with Atrial Fibrillation and Chronic Kidney Disease

Title:Meta-analysis of Clinical Outcomes of Electrical Cardioversion and Catheter Ablation in Patients with Atrial Fibrillation and Chronic Kidney Disease

Volume: 24 Issue: 24

Author(s): Igor Diemberger*, Simonetta Genovesi, Giulia Massaro, Maria Letizia Bacchi Reggiani, Jessica Frisoni, Giulia Gorlato, Erminio Mauro, Margherita Padeletti, Antonio Vincenti and Giuseppe Boriani

Affiliation:

• Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna,Italy

Keywords: Electrical cardioversion, catheter ablation, atrial fibrillation, chronic kidney disease, meta-analysis, thromboembolic events (TEs).

Abstract: Background: Chronic kidney disease (CKD) is associated with adverse outcomes in presence of atrial fibrillation (AF). However, the literature shows limited data on non-pharmacological management of AF in CKD patients.

Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients.

Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials and performed a metaanalysis. The primary outcome was recurrence of AF. The secondary outcomes were occurrence of thromboembolic events (TEs) and estimated glomerular filtration rate (eGFR) modification.

Results: Literature search yielded 26 eligible papers: 22 on CA and 4 concerning ECV. CKD patients presented more AF recurrences 30 days after ECV (OR 2.62, 95%CI 1.28-5.34; p <0.001). Patients with eGFR<60-68 ml/min and on dialysis presented a higher incidence of AF recurrences after CA, median follow up 26.0 and 29.9 months (HR 1.75, 95%CI 1.46-2.09, p <0.001; and HR 1.69, 95%CI 1.22-2.33, p <0.001; respectively). Periprocedural TEs were rare and not associated with CKD or dialysis. However, patients with CKD were at increased risk for delayed TEs after CA (HR 2.61, 95%CI 1.04-6.54; p <0.001). No significant modification of eGFR was associated with ECV or CA in the overall population.

Conclusion: ECV and CA for sinus rhythm restoration/maintenance in AF patients, albeit theoretically promising, seem to be associated with lower efficacy at medium to long-term in patients with CKD. Further studies are needed to better define the role of ECV and CA in CKD.

Cite this article as:

Diemberger Igor*, Genovesi Simonetta, Massaro Giulia , Reggiani Letizia Bacchi Maria , Frisoni Jessica , Gorlato Giulia , Mauro Erminio , Padeletti Margherita , Vincenti Antonio and Boriani Giuseppe , Meta-analysis of Clinical Outcomes of Electrical Cardioversion and Catheter Ablation in Patients with Atrial Fibrillation and Chronic Kidney Disease, Current Pharmaceutical Design 2018; 24 (24) . https://dx.doi.org/10.2174/1381612824666180829112019