title: The impact of haemodialysis on the outcomes of catheter ablation in patients with paroxysmal atrial fibrillation.
abstract: OBJECTIVE
  The outcomes of catheter ablation (CA) in patients with paroxysmal atrial fibrillation (PAF) who are undergoing haemodialysis (HD) have not been fully elucidated. This study aimed to determine the impact of HD on CA outcome in these patients.
  
  
  RESULTS
  We examined 1364 consecutive PAF patients (mean age, 61 ± 10 years) who underwent CA, including 32 (2.3%) patients undergoing HD. The patients undergoing HD had a significantly lower body mass index (P < 0.0001), higher CHADS2 score (P = 0.006), and higher prevalence of structural heart disease (P < 0.0001), hypertension (P = 0.002), and congestive heart failure (P = 0.02). Echocardiography indicated a larger left atrial diameter (P < 0.0001) and left ventricular diameter (P = 0.0002) in the HD patients. Haemodialysis was a significant predictor of AF recurrence (hazard ratio 2.56; 95% confidence interval 1.56-4.03; P = 0.0004) in the overall population. Sinus rhythm maintenance rates in the HD patients at 1, 3, and 5 years were 42.3, 37.6, and 19.7%, respectively, after the first procedure, and 64.7, 54.9, and 47.1%, respectively, after the final procedure (median, 2; range, 1-2 procedures); these rates were significantly lower than those in the non-HD patients (P < 0.0001). The 5-year survival rate was 78.1% in the HD patients.
  
  
  CONCLUSIONS
  Haemodialysis was significantly associated with AF recurrence after CA for PAF. However, an ∼50% success rate for sinus rhythm maintenance without antiarrhythmic drug therapy in HD patients suggested that CA could be an option for the treatment of AF.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahama Street 1-16, Yokosuka, Kanagawa 238-8558, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Takigawa
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Okubo
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watari
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kimura
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Takagi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hikita
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Haemodialysis; Prognosis; Recurrence