Key result
ICE-guided contrast-free cryoballoon ablation shows comparable AF recurrence in patients with and without CKD.
Why the study?
Outcomes of cryoballoon ablation in patients with atrial fibrillation and renal insufficiency are not fully elucidated, despite known associations between impaired renal function and poor outcomes after radiofrequency catheter ablation.
Does ICE-guided contrast agent-free cryoballoon ablation result in comparable clinical recurrence and safety in AF patients with CKD compared to those without CKD?
Cohort (n=839)
No
Does ICE-guided contrast agent-free cryoballoon ablation result in comparable clinical recurrence and safety in AF patients with CKD compared to those without CKD?
ICE-guided contrast-free cryoballoon ablation is safe and effective for AF patients with CKD, offering comparable recurrence rates to non-CKD patients and potential improvement in renal function.
May support ICE-guided contrast-free ablation in AF with CKD; leaves open need for randomized confirmation.
BACKGROUND AND OBJECTIVES: Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA. METHODS: A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group. CONCLUSIONS: ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.
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Shin et al. (2023) conducted a cohort in Atrial Fibrillation with Chronic Kidney Disease (n=839). Intracardiac echocardiography-guided contrast agent-free cryoballoon ablation vs. Patients without chronic kidney disease (CCr >50 mL/min) was evaluated on Clinical recurrence of atrial tachyarrhythmia lasting >30 seconds (p=0.386). Intracardiac echocardiography-guided contrast agent-free cryoballoon ablation resulted in comparable clinical recurrence rates between atrial fibrillation patients with and without chronic kidney disease (24.8% vs 21.2%, p=0.386).
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