Korean Circ J.  2024 Mar;54(3):113-123. 10.4070/kcj.2023.0194.

Clinical Outcomes of Intracardiac Echocardiography-Guided Contrast Agent-Free Cryoballoon Ablation in Atrial Fibrillation Patients With Renal Insufficiency

• Shin DG
• Ahn J
• Park SH
• Han SJ
• Lim HE

• KMID: 2554138
• DOI: http://doi.org/10.4070/kcj.2023.0194

Abstract

Background and Objectives
Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA.
Methods
A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA.
Results
In comparison with patients without CKD (CCr >50, n=722), those with CKD (CCr ≤50, n=117) were older and predominantly female, had a lower body mass index, and showed a higher prevalence of heart failure and hypertension. Mean CHA 2 DS 2 -VAS score was significantly higher in CKD group than in non-CKD group. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group.
Conclusions
ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.

Keyword

Ablation; Atrial fibrillation; Echocardiography; Renal insufficiency

Figure

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  Figure 1 Kaplan-Meier survival curves for clinical recurrence-free survival rate in overall, PAF, and non-PAF patients.CKD = chronic kidney disease; PAF = paroxysmal atrial fibrillation.

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  Figure 2 The changes in CCr between baseline and 12 months after cryoballoon ablation in overall, non-CKD, and CKD patient.CCr = creatinine clearance rate; CKD = chronic kidney disease.

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  Figure 3 The changes in CCr between baseline and 12 months after cryoballoon ablation according to the type of AF (A, B) and clinical recurrence (C, D).AF = atrial fibrillation; CCr = creatinine clearance rate; PAF = paroxysmal atrial fibrillation.

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