Abstract 332 Atrial fibrillation ablation in kidney transplant patients

Introduction:

Kidney transplant (KT) patients (pts) are at a higher risk for cardiovascular diseases (CVD) compared to the general population. Management of atrial fibrillation (AF) in KT pts is challenging for both nephrologists and cardiologists due to various drug to drug interactions between antiarrhythmic drugs (AAD) and immunosuppressive therapy. Data about safety and efficacy of catheter ablation (CA) in this patient cohort is scarce.

Objective:

to evaluate safety and efficacy of CA for symptomatic AF in KT pts.

Methods:

In this multicenter retrospective observational study, KT pts who underwent AF ablation at the University Hospital Schleswig-Holstein, Lübeck, Germany and the Luigi Sacco University Hospital, Milan, Italy between April 2017 and march 2021 were included.

Results and discussion:

A total of 11 KT pts (63.6% male, mean age 59.8 ± 11.6 years, structural heart disease in 6/11 54.5%, mean left ventricular ejection fraction 54.7 ± 8.3%) underwent CA in both centers using radiofrequency ablation (n= 9), cryoballoon ablation (n=1) or laser balloon ablation (n=1). Procedure duration was 181 min [115–201]. No contrast medium was used in 7 patients, while a median of 30 ml contrast medium (Iomeprol; 350 mg/ml) was administered in the remaining 4. Ablation strategy included pulmonary vein isolation in all pts, common type flutter ablation in one patient and linear ablation in 2 pts. Periprocedural complications occurred in one case with a pericardial tamponade treated with needle aspiration. The same patient developed transplant failure two months after the CA, requiring continuous dialysis. No further procedure related complications were documented in the remaining 10 patients. The antiarrhythmic drug therapy (AAD) was discontinued in 2 pts shortly before or after CA due to QT prolongation. At a median follow up of 22.6 months [4.0 – 30.7], 9/11(85%) pts were in sinus rhythm, including one patient on AAD. No significant difference of the mean glomerular filtration rate was observed before CA and by the time of follow-up (33.9 ± 10.3 vs 39.8 ± 7.4; paired t test p = 0.146).

Conclusions: Our data suggests that in the majority of KT patients, CA is an effective and safe treatment allowing for discontinuation of AAD therapy. This may decrease the risk of drug-to-drug interactions.

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Atrial fibrillation ablation in kidney transplant patients
A. Keelani¹, H. L. Phan¹, A. traub¹, C.-H. Heeger¹, R. R. Tilz², J. Vogler², C. Eitel¹, M. Nitschke³, J. Arand³, T. Fink⁴, V. Sciacca², A. Gasperetti⁵, G. Forleo⁵, M. Schiavone⁵
¹Med. Klinik II / Kardiologie, Elektrophysiologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ²Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ³Nephrologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ⁴Elektrophysiologie/ Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; ⁵cardiology, Luigi Sacco University Hospital, Milan, IT;
Introduction: Kidney transplant (KT) patients (pts) are at a higher risk for cardiovascular diseases (CVD) compared to the general population. Management of atrial fibrillation (AF) in KT pts is challenging for both nephrologists and cardiologists due to various drug to drug interactions between antiarrhythmic drugs (AAD) and immunosuppressive therapy. Data about safety and efficacy of catheter ablation (CA) in this patient cohort is scarce. Objective: to evaluate safety and efficacy of CA for symptomatic AF in KT pts. Methods: In this multicenter retrospective observational study, KT pts who underwent AF ablation at the University Hospital Schleswig-Holstein, Lübeck, Germany and the Luigi Sacco University Hospital, Milan, Italy between April 2017 and march 2021 were included. Results and discussion: A total of 11 KT pts (63.6% male, mean age 59.8 ± 11.6 years, structural heart disease in 6/11 54.5%, mean left ventricular ejection fraction 54.7 ± 8.3%) underwent CA in both centers using radiofrequency ablation (n= 9), cryoballoon ablation (n=1) or laser balloon ablation (n=1). Procedure duration was 181 min [115–201]. No contrast medium was used in 7 patients, while a median of 30 ml contrast medium (Iomeprol; 350 mg/ml) was administered in the remaining 4. Ablation strategy included pulmonary vein isolation in all pts, common type flutter ablation in one patient and linear ablation in 2 pts. Periprocedural complications occurred in one case with a pericardial tamponade treated with needle aspiration. The same patient developed transplant failure two months after the CA, requiring continuous dialysis. No further procedure related complications were documented in the remaining 10 patients. The antiarrhythmic drug therapy (AAD) was discontinued in 2 pts shortly before or after CA due to QT prolongation. At a median follow up of 22.6 months [4.0 – 30.7], 9/11(85%) pts were in sinus rhythm, including one patient on AAD. No significant difference of the mean glomerular filtration rate was observed before CA and by the time of follow-up (33.9 ± 10.3 vs 39.8 ± 7.4; paired t test p = 0.146). Conclusions: Our data suggests that in the majority of KT patients, CA is an effective and safe treatment allowing for discontinuation of AAD therapy. This may decrease the risk of drug-to-drug interactions.
https://dgk.org/kongress_programme/ht2021/P430.htm