TO036
THE IMPACT OF CATHETER ABLATION ON HEMODIALYSIS PATIENTS WITH ATRIAL FIBRILLATION

Introduction and Aims: Atrial fibrillation (AF) is more common in hemodialysis (HD) patients than the general public. It can cause hemodynamic deterioration such as low blood pressure during HD. Furthermore, around a third of HD patients with AF suffer from thromboembolic complications within one year. The adverse effects of antiarrhythmic drugs offset the benefits of the sinus rhythm. Warfarin is not recommended because of a high risk of mortality. Thus, treatment options are limited. Recently, radiofrequency catheter ablation with pulmonary vein isolation has been developed as a nonsurgical approach for patients with AF. We evaluated the effects of radiofrequency catheter ablation in HD patients with AF.

Methods: Among 140 patients receiving HD therapy, we divided 35 patients with atrial fibrillation into a catheter ablation treatment group and an observation group according to patient's will. Thirty (18 males and 12 females; mean age 74.1 ± 10.3, range 53-94 years; mean HD duration 115.6 ± 74.5 months) with AF (paroxysmal AF, n = 26; persistent AF, n = 4) were enrolled in the catheter ablation treatment group. Five patients didn't consent catheterization(2 males and3 females; mean age 82.0 ± 7.5, range 74-91 years; mean HD duration 61.2 ± 44.9 months, paroxysmal AF, n = 3; persistent AF, n = 2), three patients were given an antiplatelet drug and two patients were given an anticoagulant. We completely isolated the whole posterior left atrium including all pulmonary veins (box isolation) guided by a 3D-mapping system (Ensite NavX, USA).

Results: Among 30 patients, who underwent box isolation therapy, 2 patients (6.7%) had two sessions, 2 patients needed three sessions and 2 patients needed four sessions because of AF recurrence. In one patient, five sessions were required. Among the ablation group, 12 patients died (two Sepsis after operation, two unknown, Cerebral hemorrhage, Idiopathic thrombocytopenic purpura, Acute myocardial infarction, Idiopathic bacterial peritonitis, Lung small cell carcinoma, Pleuritis, Infection of the renal cyst, Lung adenocarcinoma) and 3 patients changed hospitals. At 31.1 ± 20.9 months of follow-up, all patient were free from recurrent AF or atrial tachycardia, and 24 of 25 patients with paroxysmal AF had no AF during HD. In one patient, paroxysmal AF recurred but he did not request another session and paroxysmal AF remained. One patient developed cervical hematoma due to sudden movement during therapy. Cerebral infarction did not occur during the follow-up period in 29 patients. There were no other complications. Among the observation group of three people, one person died because of severe cerebral infarction, and cerebral infarction developed in other one person. There were significant differences about frequency of cerebral infarction between the two groups. (Pearson's chi-square test, p=0.0004)

Conclusions: In this study, radiofrequency catheter ablation achieved maintenance of sinus rhythm in 29 out of 30 HD patients with AF. Only one case of myocardial infarction occurred among 29 patients during 30.8 ± 21.2 months of follow-up. Cerebral infarction did not occur at all during the observation period in the 74.4 patient-years. Cerebral infarction occurred significantly fewer times among treatment groups than observation group. Therefore, cerebral infarction may be reduced by this treatment.