Outcomes Following Pulmonary Vein Isolation in ESRD Patients: USRDS-Based Outcome Data
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Background
In End-Stage Renal Disease (ESRD) patients, the coexistence of AF significantly elevates the risks of stroke (4.8 - 5.6 per 100 person-years) and mortality (26.9 per 100 person-years). Current AF literature lacks insights into pulmonary vein isolation (PVI) outcomes in this population. We aimed to assess the outcomes of PVI in ESRD patients with AF.
Methods and Materials
We included all adult patients with a pre-existing diagnosis of ESRD and at least one prior admission for AF from the United States Renal Data System (USRDS) registry and stratified them according to Pulmonary Vein Isolation (PVI). Those with prior transplantation were excluded. Kaplan-Meier curves were used for time-to-evet analysis. Logistic regression analysis was used to assess hazard ratios. Propensity score analysis was used to evaluate the treatment effect after adjusting for covariates.
Results
The study included 103,982 ESRD patients with AF, of whom 4,314 (4.15%) received ablation, and 99,668 (95.85%) were managed medically. After matching, there was a reduction in mortality (90.2% vs 93.4%, p<0.001) among the ablation group compared to no ablation at 5 years. Increased age (60-69 years and ≥70 years) was associated with 3-fold and 6-fold higher odds of mortality, respectively. A history of congestive heart failure increased the odds of mortality by 36%, while prior stroke, coronary disease, and cancer did not.
Conclusion
In ESRD patients with AF, despite a high 5-year mortality, those who undergo PVI exhibit a lower mortality rate compared to those managed without PVI.
