Safety and efficacy of atrial fibrillation ablation in kidney transplant patients

Abstract Introduction Managing atrial fibrillation in kidney transplant patients poses a challenge for both nephrologists and cardiologists. Data regarding the safety and efficacy of catheter ablation in this patient’s cohort is scarce. Methods and results In this two-center prospective study, we included all consecutive kidney transplant patients who underwent atrial fibrillation ablation between April 2017 and March 2022. A 1:3 propensity score matching created a control group of non-transplant AF patients undergoing ablation. We included 16 kidney transplant patients and 48 matched controls. Ablation was successful in all patients. The periprocedural complication rate (6.3% in the kidney transplant group vs. 6.3% in the control group, p value = 1) did not differ between the two groups. One transplant patient experienced graft dysfunction after a complication. At 18 months, AF recurrence-fee rates were 69% in the transplant group and 70.1% in controls ( p = 0.95). By the last follow-up, all transplant patients had discontinued antiarrhythmic drugs, while 19.6% of the patients in the control group were treated with antiarrhythmic drugs ( p = 0.09). Kidney function in the transplant group remained stable (eGFR 32 23.8, 40.5 ml/min/1.73 m 2 before vs. 34 29.8, 38 ml/min/1.73 m 2 at last follow up, p = 0.93). Conclusions This study demonstrates that catheter ablation is a viable option for treating AF in kidney transplant patients, with comparable outcomes to non-transplanted individuals. Discontinuing antiarrhythmic drugs reduces drug interaction risks, but minimizing procedural complications remains critical to preserving graft function. Graphical Abstract