Impact of chronic kidney disease on atrial fibrillation recurrence following radiofrequency and cryoballoon ablation: A meta‐analysis

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In observational studies, patients with chronic kidney disease (CKD) exhibited a controversial risk of atrial fibrillation (AF) recurrence following radiofrequency (RF) or cryoballoon ablation compared with non-CKD patients. This meta-analysis analysed the impact of CKD on AF recurrence following ablation. We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov databases for articles published between January 1, 2010, and May 31, 2020. In total, seven observational studies with 23468 patients were analysed. Data included demographics, AF classification, left atrial size, incidence of AF recurrence, and ablation method. The prevalence of CKD was 8.0% (7.6%-24.4%) in the AF ablation population. The CKD population was older and had a higher prevalence of diabetes mellitus, hypertension, and heart failure, a higher CHA2DS2-VASc score, larger left atrial dimension, and lower left ventricular ejection fraction compared with the non-CKD population. The CKD patients had a higher AF recurrence rate following ablation than non-CKD patients (odds ratio [OR], 3.71; 95% confidence interval (CI), 1.35-10.19). CKD was associated with higher AF recurrent risk after ablation in patients with only paroxysmal AF (OR=4.81, 95% CI 2.48-9.35). CKD was associated with higher AF recurrent risk in patients receiving radiofrequency ablation (OR=3.28, 95% CI 2.17-4.94) or cryoballoon ablation (OR=6.50, 95% CI 2.24-18.89) and in Asian region (OR=4.86, 95% CI, 2.69-8.78). CKD population had worse outcomes in terms of AF recurrence following RF or cryoballoon ablation.