title: Efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in chronic hemodialysis patients.
abstract: BACKGROUND
  Radiofrequency catheter ablation (RFCA) is increasingly performed for the treatment of atrial fibrillation (AF), but it is problematic because the use of anti-arrhythmic agents is largely restricted in patients undergoing hemodialysis (HD) therapy. However, little is known about the long-term clinical outcomes of AF after RFCA in HD patients.
  
  
  METHODS
  Between 2002 and 2008, 16 HD patients (age: 63.8 ± 7.4 years, 75.0% men) underwent RFCA for AF at the Toyota Kosei Hospital. We investigated the long-term results and mortality of RFCA for AF in HD patients and compared them with those of 111 non-HD patients (age: 58.6 ± 10.0 years, 78.3% male) who received the same procedures.
  
  
  RESULTS
  During the follow-up (64.3 ± 25.4 months in HD patients, 70.5 ± 20.2 months in non-HD patients) after the initial RFCA procedure, sinus rhythm was restored in 4 HD patients (25%) and in 45 non-HD patients (40.5%). Multiple procedures were performed in 12 HD patients and in 57 non-HD patients. After the final procedure, 13 HD patients (81.3%) and 92 non-HD patients (82.9%) were free of atrial arrhythmia and symptoms. Of importance, Kaplan-Meier analysis did not demonstrate any significant differences in the atrial arrhythmia-free rate after the last procedure between HD patients and the control group matched after propensity-score analysis despite higher all-cause mortality in HD patients than in non-HD patients.
  
  
  CONCLUSIONS
  During 5-years of follow-up, the use of multiple RFCA procedures for AF in patients undergoing HD was favorable, whereas the use of a single procedure was disappointing. Multiple RFCA procedures can be an efficient approach to the treatment of AF in HD patients.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Hayashi
authors.forename: Shinji
authors.initials: S
authors.lastname: Kaneko
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimano
authors.forename: Taiki
authors.initials: T
authors.lastname: Ohashi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kubota
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Takeshita
authors.forename: Masanori
authors.initials: M
authors.lastname: Shinoda
authors.forename: Yasuya
authors.initials: Y
authors.lastname: Inden
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kanayama
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000628:therapy*; D017115:Catheter Ablation; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012008:Recurrence; D006435:Renal Dialysis; D019233:Retreatment; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: atrial fibrillation; catheter ablation; hemodialysis