Safety and Efficacy of Pulsed Field Ablation for Atrial Fibrillation in Patients With Chronic Kidney Disease.

Background

Atrial fibrillation (AF) and chronic kidney disease (CKD) are prevalent conditions linked by multiple shared risk factors.

Objective

This study aimed to compare periprocedural safety and long-term efficacy outcomes of pulsed field ablation (PFA) for AF in patients with and without CKD.

Methods

Consecutive patients from a major health system in the United States were included in the analysis. Based on baseline eGFR, patients were categorized as no CKD, mild CKD (eGFR ≥45 mL/min/1.73 m2), moderate CKD (eGFR 30-44 mL/min/1.73 m2), and advanced CKD (eGFR <30 mL/min/1.73 m2). Periprocedural safety was assessed based on the occurrence of non-renal procedural complications and acute kidney injury (AKI). For long-term analysis, AF recurrence-free survival was compared.

Results

A total of 2,269 patients were included: 1,829 without CKD, 314 with mild CKD, 103 with moderate CKD, and 23 with advanced CKD. Mean age was 66.9 (±10.2) years and 716 (31.6%) patients were female. Non-renal procedural complications occurred in 5.9% of patients; after multivariable adjustment, no CKD category was independently associated with this outcome. AKI occurred in 4.9% of patients with available post-procedural renal function data. A decreased eGFR was independently associated with AKI (OR 0.96, 95% CI 0.94-0.99 P<0.01). Estimated 12-month AF-free survival was comparable between patients with and without CKD (HR 1.20; 95% CI 0.93-1.59; P=0.1).

Conclusion

PFA for AF is feasible in patients with CKD. However, patients with a decreased eGFR had a significantly higher risk of AKI and presented a numerically higher rate of non-renal complications.