Introduction <p>Managing atrial fibrillation in kidney transplant patients poses a challenge for both nephrologists and cardiologists. Data regarding the safety and efficacy of catheter ablation in this patient’s cohort is scarce.</p> Methods and results <p>In this two-center prospective study, we included all consecutive kidney transplant patients who underwent atrial fibrillation ablation between April 2017 and March 2022. A 1:3 propensity score matching created a control group of non-transplant AF patients undergoing ablation. We included 16 kidney transplant patients and 48 matched controls. Ablation was successful in all patients. The periprocedural complication rate (6.3% in the kidney transplant group vs. 6.3% in the control group, <i>p</i> value = 1) did not differ between the two groups. One transplant patient experienced graft dysfunction after a complication. At 18&#xa0;months, AF recurrence-fee rates were 69% in the transplant group and 70.1% in controls (<i>p</i> = 0.95). By the last follow-up, all transplant patients had discontinued antiarrhythmic drugs, while 19.6% of the patients in the control group were treated with antiarrhythmic drugs (<i>p</i> = 0.09). Kidney function in the transplant group remained stable (eGFR 32 [23.8, 40.5] ml/min/1.73 m<sup>2</sup> before vs. 34 [29.8, 38] ml/min/1.73 m<sup>2</sup> at last follow up, <i>p</i> = 0.93).</p> Conclusions <p>This study demonstrates that catheter ablation is a viable option for treating AF in kidney transplant patients, with comparable outcomes to non-transplanted individuals. Discontinuing antiarrhythmic drugs reduces drug interaction risks, but minimizing procedural complications remains critical to preserving graft function.</p> Graphical Abstract <p></p>

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Safety and efficacy of atrial fibrillation ablation in kidney transplant patients

  • Ahmad Keelani,
  • Lorenzo Bartoli,
  • Alessio Gasperetti,
  • Sorin Popescu,
  • Marco Schiavone,
  • Anna Traub,
  • Huong-Lan Phan,
  • Marcel Feher,
  • Thomas Fink,
  • Vanessa Sciacca,
  • Martin Nitschke,
  • Julia Vogler,
  • Charlotte Eitel,
  • Giovanni Forleo,
  • Christian-H. Heeger,
  • Roland R. Tilz

摘要

Introduction

Managing atrial fibrillation in kidney transplant patients poses a challenge for both nephrologists and cardiologists. Data regarding the safety and efficacy of catheter ablation in this patient’s cohort is scarce.

Methods and results

In this two-center prospective study, we included all consecutive kidney transplant patients who underwent atrial fibrillation ablation between April 2017 and March 2022. A 1:3 propensity score matching created a control group of non-transplant AF patients undergoing ablation. We included 16 kidney transplant patients and 48 matched controls. Ablation was successful in all patients. The periprocedural complication rate (6.3% in the kidney transplant group vs. 6.3% in the control group, p value = 1) did not differ between the two groups. One transplant patient experienced graft dysfunction after a complication. At 18 months, AF recurrence-fee rates were 69% in the transplant group and 70.1% in controls (p = 0.95). By the last follow-up, all transplant patients had discontinued antiarrhythmic drugs, while 19.6% of the patients in the control group were treated with antiarrhythmic drugs (p = 0.09). Kidney function in the transplant group remained stable (eGFR 32 [23.8, 40.5] ml/min/1.73 m2 before vs. 34 [29.8, 38] ml/min/1.73 m2 at last follow up, p = 0.93).

Conclusions

This study demonstrates that catheter ablation is a viable option for treating AF in kidney transplant patients, with comparable outcomes to non-transplanted individuals. Discontinuing antiarrhythmic drugs reduces drug interaction risks, but minimizing procedural complications remains critical to preserving graft function.

Graphical Abstract