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Chronic Kidney Disease Should Not Exclude Patients with Low Atrial Fibrosis from Catheter Ablation Therapy for Atrial Fibrillation

We are happy to review the letter to the editor by Dr. Kornej et al. with regard to our paper entitled “Improvement in Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease Undergoing Catheter Ablation for Atrial Fibrillation.” As it is well known, chronic kidney disease (CKD) patients with atrial fibrillation (AF) are a special population because reduced kidney function excludes them from some antiarrhythmic drug therapies. They are also at an increased risk of stroke as well as bleeding while on oral anticoagulation. Our study summarized our experience with this patient population undergoing de novo catheter ablation, including an assessment of atrial remodeling using cardiac MRI. The messages from our recent publication were (1) the stage of CKD at baseline was not found to be an independent predictor of arrhythmia recurrence and should not preclude these patients from undergoing catheter ablation for the treatment of AF; (2) CKD stage was not a predictor of atrial fibrosis by MRI; (3) the estimated glomerular filtration rate (eGFR) was significantly improved postablation, especially when there was no recurrence of arrhythmia.1 Our manuscript acknowledged that our study had certain limitations, some of which are pointed out in the letter to the editor. The average time between baseline and repeat eGFR was around 3 months. Takahashi et al.2 examined eGFR prospectively in a Japanese cohort at 3 months and at 1 year following ablation and, similar to our findings, showed improvements in eGFR, especially with no arrhythmia recurrence. The magnitude of improvement at 3 months in our report is higher than the Takahashi study and also that mentioned by Korneij et al. in their letter. It is plausible that with longer follow-up, further changes in eGFR might occur. Unfortunately, the paper described by Korneij summarizing