Background: Chronic kidney disease (CKD) is associated with adverse outcomes in presence of atrial
fibrillation (AF). However, the literature shows limited data on non-pharmacological management of AF in CKD
Aim: summarizing the available data on outcomes associated with electrical cardioversion (ECV) and AF catheter
ablation (CA) in CKD patients.
Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials and performed a metaanalysis.
The primary outcome was recurrence of AF. The secondary outcomes were occurrence of thromboembolic
events (TEs) and estimated glomerular filtration rate (eGFR) modification.
Results: Literature search yielded 26 eligible papers: 22 on CA and 4 concerning ECV. CKD patients presented
more AF recurrences 30 days after ECV (OR 2.62, 95%CI 1.28-5.34; p <0.001). Patients with eGFR<60-68
ml/min and on dialysis presented a higher incidence of AF recurrences after CA, median follow up 26.0 and 29.9
months (HR 1.75, 95%CI 1.46-2.09, p <0.001; and HR 1.69, 95%CI 1.22-2.33, p <0.001; respectively). Periprocedural
TEs were rare and not associated with CKD or dialysis. However, patients with CKD were at increased
risk for delayed TEs after CA (HR 2.61, 95%CI 1.04-6.54; p <0.001). No significant modification of
eGFR was associated with ECV or CA in the overall population.
Conclusion: ECV and CA for sinus rhythm restoration/maintenance in AF patients, albeit theoretically promising,
seem to be associated with lower efficacy at medium to long-term in patients with CKD. Further studies are
needed to better define the role of ECV and CA in CKD.