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

Igor Diemberger, Simonetta Genovesi, Giulia Massaro, Maria Letizia Bacchi Reggiani, Jessica Frisoni, Giulia Gorlato, Erminio Mauro, Margherita Padeletti, Antonio Vincenti, Giuseppe Boriani

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Background: 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. Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)2794-2801
Number of pages8
JournalCurrent Pharmaceutical Design
Volume24
Issue number24
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Electric Countershock
Catheter Ablation
Chronic Renal Insufficiency
Atrial Fibrillation
Meta-Analysis
Glomerular Filtration Rate
Recurrence
Dialysis
MEDLINE
Maintenance
Incidence

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Chronic kidney disease
  • Electrical cardioversion
  • Meta-analysis
  • Thromboembolic events (TEs)

ASJC Scopus subject areas

  • Pharmacology
  • Drug Discovery

Cite this

Meta-analysis of clinical outcomes of electrical cardioversion and catheter ablation in patients with atrial fibrillation and chronic kidney disease. / Diemberger, Igor; Genovesi, Simonetta; Massaro, Giulia; Reggiani, Maria Letizia Bacchi; Frisoni, Jessica; Gorlato, Giulia; Mauro, Erminio; Padeletti, Margherita; Vincenti, Antonio; Boriani, Giuseppe.

In: Current Pharmaceutical Design, Vol. 24, No. 24, 01.01.2018, p. 2794-2801.

Research output: Contribution to journalReview article

Diemberger, Igor ; Genovesi, Simonetta ; Massaro, Giulia ; Reggiani, Maria Letizia Bacchi ; Frisoni, Jessica ; Gorlato, Giulia ; Mauro, Erminio ; Padeletti, Margherita ; Vincenti, Antonio ; Boriani, Giuseppe. / Meta-analysis of clinical outcomes of electrical cardioversion and catheter ablation in patients with atrial fibrillation and chronic kidney disease. In: Current Pharmaceutical Design. 2018 ; Vol. 24, No. 24. pp. 2794-2801.
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abstract = "Background: 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. Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. Methods: 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. Results: 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. Conclusion: 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.",
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T1 - Meta-analysis of clinical outcomes of electrical cardioversion and catheter ablation in patients with atrial fibrillation and chronic kidney disease

AU - Diemberger, Igor

AU - Genovesi, Simonetta

AU - Massaro, Giulia

AU - Reggiani, Maria Letizia Bacchi

AU - Frisoni, Jessica

AU - Gorlato, Giulia

AU - Mauro, Erminio

AU - Padeletti, Margherita

AU - Vincenti, Antonio

AU - Boriani, Giuseppe

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: 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. Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. Methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter ablation (CA) in CKD patients. Methods: 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. Results: 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. Conclusion: 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.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Chronic kidney disease

KW - Electrical cardioversion

KW - Meta-analysis

KW - Thromboembolic events (TEs)

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