AB-452666-1 EFFICACY AND OUTCOMES OF CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH END-STAGE RENAL DISEASE: ANALYSIS OF NATIONWIDE READMISSION DATABASE

Abstract

End-stage renal disease (ESRD) is an independent risk factor for atrial fibrillation (AF). Catheter ablation (CA) for AF is a well-established, safe treatment option and is increasingly utilized. However, there is a paucity of current data on the efficacy and safety of CA for AF in patients with ESRD. To investigate the efficacy of AF ablation in patients with ESRD. We conducted a retrospective analysis of the Nationwide Readmission Database (NRD) from January 2016 to December 2019. Patients with AF and ESRD were identified using ICD-10-CM codes. The study cohort was further divided into two groups based on CA. Any admission within 180 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcome was AF readmission and secondary outcomes were mortality readmission, ischemic stroke readmission, heart failure readmission, major bleeding readmission and all cause readmission. We identified 200,555 ESRD patients admitted with AF during the study period. Out of these, 786 (0.4%) patients underwent CA for AF. Patients who underwent CA for AF were younger (median age in years, 67 vs 71, p<0.001), less likely to be females (32.2% vs 41.5%, p<0.001). After adjusting for confounders, patients with ESRD who underwent AF ablation had a significantly lower risk of readmission for AF (adjusted HR 0.88, 95% CI 0.80-0.97, p=0.01). Patients who underwent CA for AF also had a lower risk of readmission for HF (aHR 0.83, 95% CI 0.74-0.92, p=0.01), major bleeding (aHR 0.59, 95% CI 0.41-0.85, p=0.005), and all-cause readmission (aHR 0.87, 95% CI 0.79-0.95, p=0.02). Lastly, patients in AF ablation group also had lower all-cause in-hospital mortality (aHR 0.74, 95% CI 0.57-0.96, p=0.02). In patients with ESRD and AF, catheter ablation was associated with a lower risk of AF, HF, and all-cause readmission compared to patients who did not undergo ablation. AF ablation was also associated with significantly lower all-cause mortality. Further research is needed to establish CA's efficacy and long-term outcomes in patients with ESRD and AF.