Long-Term Follow-Up after Catheter Ablation of Paroxysmal Atrial Fibrillation in Patients with Chronic Kidney Disease Undergoing Hemodialysis

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Background: Chronic kidney disease (CKD), especially progressed renal dysfunction requiring hemodialysis (HD), is associated with an increased prevalence of atrial fibrillation (AF). However, the effectiveness of the pulmonary vein isolation (PVI) for paroxysmal AF in HD patients has not been fully investigated. This study was undertaken to clarify this point. Methods and Results: We enrolled 208 patients with drug-refractory paroxysmal AF (mean age 58.6±9.2 years, male 165), of whom 8 was on HD. No statistically significant differences in the baseline clinical characteristics were observed between HD and non-HD patients. PVI was completed in all patients, and during the procedure, ectopies from pulmonary veins triggering AF were detected in 110/208 (53%). The HD patients had significantly lower incidence of trigger from pulmonary vein than the non-HD patients (1/8 [13%] vs. 109/200 [55%], p=0.028). During mean follow-up of 73±9.9 months after 1.6±0.7 procedures, 168/208 (81%) were free from recurrent arrhythmias without using antiarrhythmic drugs. Recurrence of AF was significantly higher in the HD patients than non-HD patients (4/8 [50%] vs. 36/200 [18%], p=0.046). Conclusion: The end-stage CKD on HD was related to the recurrence of AF after PVI. PVI alone may be insufficient treatment for elimination of PAF in the HD patients, suggesting the presence of non-PV foci triggering AF.