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Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation.

BACKGROUND
Recent observational studies have shown that patients with chronic kidney disease (CKD) have higher risk of atrial fibrillation (AF) recurrence and, therefore, the value of catheter ablation therapy in patients with CKD has been doubted. The purpose of this meta-analysis was to systematically analyze the effect of CKD on recurrence of AF following catheter ablation.


METHODS
PubMed and Cochrane clinical trials databases were searched until August 2012. Of the 1966 initially identified studies, 4 observational studies with 1379 patients were analyzed.


RESULTS
The meta-analysis of these studies showed that CKD was associated with higher AF recurrence rate following single catheter ablation (HR = 1.96, 95% CI 1.35-2.85, p = 0.0004) while there were significant differences between individual trials (p = 0.07 and I2 = 58%). Sensitivity analysis suggested that this outcome was stable. A subgroup analysis showed that CKD has higher recurrent risk in patients with 100% paroxysmal AF (HR = 2.45, 95% CI 1.28-4.70, p = 0.007) than in patients with non 100% paroxysmal AF (HR = 1.65, 95% CI 1.15-2.36, p = 0.006).


CONCLUSIONS
CKD was associated with higher AF recurrence rate following single catheter ablation. In addition, patients with 100% paroxysmal AF have higher risk than patients with non 100% paroxysmal AF that merits special consideration when evaluating patients for catheter-based AF ablation. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of catheter ablation candidates.