Catheter ablation for patients on hemodialysis with symptomatic atrial fibrillation

BACKGROUND: There are limited studies on the efficacy and safety of catheter ablation (CA) for patients with atrial fibrillation (AF) who receive intermittent hemodialysis (HD). This gap in the contemporary literature is notable as patients with AF receiving HD has higher incidence of AF and does not often tolerate medical management due to renal failure. METHODS: From Mar 2015 and Jan 2018, 25 consecutive patients on regular HD from two cardiac centers who underwent CA were retrospectively enrolled. Another 100 patients without HD or renal impairment, matched by age, sex, and AF type, were enrolled from these cardiac centers as the control group. All patients were followed up at month 3, 6, and every 6 months after the first CAs for 4 years, and 2.5 years after a second CA (if applicable), unless endpoints were reached. The primary endpoint was AF recurrence after CA, and the secondary endpoints included symptomatic AF and all-cause mortality during the follow-up period. RESULTS: AF patients receiving intermittent HD had a higher prevalence of hypertension (P=0.005), and heart failure (P=0.041). During the mean follow-up period of 37.6±17.4 months after the first CA, 14 out of the 25 HD patients (56.0%) remained free from AF recurrence, compared with 77 in the control patients (77.0%; P=0.021). Twenty (80.0%) patients in the HD group did not experience symptomatic AF. Second CAs were performed on 5 HD patients and 11 control patients, consequently 4 out of 5 (80.0%) HD patients and 7 out of 11 (63.6%) control patients had no AF recurrence (P=0.626) within 21.1±12.0 months after the second CA. Tamponade was the only procedural complication documented in both groups. All-cause mortality was higher in the HD group (log-rank P=0.004); however, the observed mortality was not related to AF recurrence. CONCLUSIONS: CA is a potential efficacious and safe treatment of AF for HD patients. The AF recurrence rate is higher after a single ablation compared with the general population, but multiple ablations seem to improve outcomes for HD patients.