Meta-analysis of clinical outcomes of electrical cardioversion and catheter ablation in patients with atrial fibrillation and chronic kidney disease

• Published in: Current pharmaceutical design
• Main Authors: Diemberger, Igor, Genovesi, Simonetta, Massaro, Giulia, Reggiani, Maria Letizia Bacchi, Frisoni, Jessica, Gorlato, Giulia, Mauro, Erminio, Padeletti, Margherita, Vincenti, Antonio, Boriani, Giuseppe
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01.01.2018
• Subjects: electrical cardioversion; meta-analysis; atrial fibrillation; chronic kidney disease; catheter ablation
• ISSN: 1873-4286
• DOI: 10.2174/1381612824666180829112019

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. summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. We searched MEDLINE and the Cochrane Central Register of Controlled Trials and performed a meta-analysis. The primary outcome was recurrence of AF. The secondary outcomes were occurrence of thromboembolic events (TEs) and estimated glomerular filtration rate (eGFR) modification. 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). Peri-procedural 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. 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.