Catheter Ablation for Atrial Fibrillation in Patients with Chronic Hemodialysis

概要

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Patients with chronic hemodialysis (HD) have a high incidence of atrial fibrillation (AF) and receive strong influences on hemodynamics by AF burden especially during hemodialysis. Restriction of use of antiarrhythmic agents on HD patients resulted in difficult of rhythm management. Catheter ablation of AF has been one of reliable rhythm management tools in patients without renal dysfunction, but has not been elucidated in patients with HD fully. Methods: Thirty-eight HD patients with AF underwent pulmonary vein isolation (PVI) and added left atrium ablation. In HD patients, 23 patients were ablated using non-irrigation tip catheter (Group Non-IR) and 15 patients using irrigation tip catheter (Group IR). A group of 46 patients without renal dysfunction who underwent AF ablation (Group Control: matched with age, sex, LA dimension, and type of AF) acted as control subjects. Results: The rate of recurrent AF after the initial session was greater in Group Non-IR and Group IR than Control (52.2%, 48.4% and 26.1%, p<0.05). The AF-free survival rate after the final procedure was greater in Group Non-IR and Group IR than Control (60.3%, 74.5% and 89.0%, p<0.05). Conclusions: Catheter ablation in HD patients might be useful for management of AF, but effectiveness would be inferior compared to non-HD patients. Ablation strategy using irrigation tip catheter might improve the effectiveness in HD patients.