Heart Rhythm. 2026 Oct 6:S1547-5271(26)02857-2. doi: 10.1016/j.hrthm.2026.09.053. Online ahead of print.
ABSTRACT
BACKGROUND: Atrial fibrillation (AF) and chronic kidney disease (CKD) are prevalent conditions linked by multiple shared risk factors.
OBJECTIVE: This study aimed to compare periprocedural safety and long-term efficacy outcomes of pulsed field ablation (PFA) for AF in patients with and without CKD.
METHODS: Consecutive patients from a major health system in the United States were included in the analysis. Based on baseline eGFR, patients were categorized as no CKD, mild CKD (eGFR ≥45 mL/min/1.73 m2), moderate CKD (eGFR 30-44 mL/min/1.73 m2), and advanced CKD (eGFR <30 mL/min/1.73 m2). Periprocedural safety was assessed based on the occurrence of non-renal procedural complications and acute kidney injury (AKI). For long-term analysis, AF recurrence-free survival was compared.
RESULTS: A total of 2,269 patients were included: 1,829 without CKD, 314 with mild CKD, 103 with moderate CKD, and 23 with advanced CKD. Mean age was 66.9 (±10.2) years and 716 (31.6%) patients were female. Non-renal procedural complications occurred in 5.9% of patients; after multivariable adjustment, no CKD category was independently associated with this outcome. AKI occurred in 4.9% of patients with available post-procedural renal function data. A decreased eGFR was independently associated with AKI (OR 0.96, 95% CI 0.94-0.99 P<0.01). Estimated 12-month AF-free survival was comparable between patients with and without CKD (HR 1.20; 95% CI 0.93-1.59; P=0.1).
CONCLUSION: PFA for AF is feasible in patients with CKD. However, patients with a decreased eGFR had a significantly higher risk of AKI and presented a numerically higher rate of non-renal complications.
PMID:42838316 | DOI:10.1016/j.hrthm.2026.09.053