Catheter Ablation Reduces Long-Term Adverse Renal Events in Atrial Fibrillation Patients with Chronic Kidney Disease

Atrial fibrillation (AF) is associated with impaired renal function and chronic kidney disease (CKD). In our study, we aimed to determine the effect of cryoballoon-ablation (CBA) treatment on long-term renal prognosis parameters in paroxysmal-AF patients with CKD. In this retrospective-cohort study, 265-patients with paroxysmal-AF and concomitant CKD (eGFR < 60 mL/min/1.73 m2) between 2013–2023 were identified. 129-patients who underwent CBA for paroxysmal-AF and 101-patients who did not undergo CBA were included. Patients were follow-up for 24-month for adverse renal events. Adverse renal events were defined as (i) ≥ 30% decrease in eGFR, (ii)development of renal failure (eGFR < 15 mL/min/1.732) and hemodialysis, iii)hospitalization, and iv)renal-cardiovascular death. Patients who did not undergo CBA had higher rates of eGFR decline ≥ 30%, development of renal failure or hemodialysis, hospitalization, and death at follow-up (p < 0.001 for each). During the follow-up of patients who underwent CBA, AF recurrence occurred in 40(31%) cases. The eGFR levels of patients without CBA were significantly decreased at 24-month (32.8 ± 11.6–28.8 ± 10.3, p = 0.034). In patients who underwent CBA, eGFR levels were significantly increased at 24-month (50.4 ± 8.5–66.3 ± 13.1, p < 0.001). Logistic regression analyses was determined that the only parameter that best predicted progression of kidney disease was the presence of CBA (OR = 0.192, %95CI 0.063‒0.590, p = 0.004). In AF patients with CKD, CBA was shown to reduce the risk of long-term adverse renal events and improve renal function in accordance with previous studies. Our opinion is that AF patients who develop CKD at the time of initial diagnosis or during follow-up should be followed closely and referred for CBA.