Abstract and Introduction
Abstract
AF Ablation in HD Patients.
Introduction: It is not common for patients on chronic hemodialysis (HD) to undergo catheter ablation of atrial fibrillation (AF). We aimed to show the outcomes of AF ablation in the HD patients.
Methods and Results: Thirty HD patients who underwent pulmonary vein (PV) isolation for drug refractory paroxysmal AF were retrospectively studied, and their AF recurrence free rate and frequency of periprocedural complications were compared to 60 age- and gender-matched control patients not requiring HD. A nonirrigated ablation catheter was used in both patient groups. During a mean follow-up period of 821 ± 218 days, 16 (54%) of the HD patients remained free from AF recurrence without any antiarrhythmic agents versus 47 (78%) of the control patients with an initial ablation (P = 0.013). A second ablation procedure was performed in 12 patients with an AF recurrence, and consequently 20 (67%) of the HD patients were in sinus rhythm compared to 53 (88%) of the controls during a follow-up duration of 747 ± 221 after the last ablation (P = 0.012). Bleeding from the venipuncture site requiring a prolonged hospital stay was identified in 2 HD patients and 1 control subject, while no life-threatening complications were observed in either patient group.
Conclusion: Although the success rate of the PV isolation in HD patients was far from satisfactory, it may be considered as one of the therapeutic options for them. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1289–1294, December 2012)
Introduction
Atrial fibrillation (AF) is frequently observed with a prevalence of 13–27% in patients on chronic hemodialysis (HD), and the HD patients with AF have a higher mortality compared to those without. In clinical practice, once AF with a rapid ventricular response occurs during HD sessions, it sometimes requires changing the dialysis setting or even stopping the HD session due to a hemodynamic compromise or complaints of palpitations. Nevertheless, it is often difficult to treat repetitive episodes of AF using antiarrhythmic drugs (AADs) in the HD patients because many of them are eliminated by renal excretion. Furthermore, even if the AADs can be administered they have quite a limited effect. Therefore, a more reliable therapy for AF in the HD patients would be required.
During the past decade, catheter ablation of AF has rapidly evolved. Because the validity and safety of the ablation of AF has become widely recognized, its indications have recently been extended. Therefore, given the increasing number of patients requiring chronic HD and the difficulty in treating the AF with medical therapy in these patients, it should be of importance to know how effective this nonpharmacological therapy would be in the HD patients with AF. However, to the best of our knowledge, currently there are no data available on this issue. We therefore reported in this study the outcomes of AF ablation in HD patients.