Abstract
Background - An effective treatment of symptomatic Atrial fibrillation (AF) is the second-generation cryoballoon (CB2) based pulmonary vein isolation (PVI). However, this technique is associated with an increased exposure to contrast media and little is known about postprocedural acute kidney injury (AKI).
Objective - We evaluated the incidence, characteristics and risk factors of contrast-associated AKI after CB2-based catheter ablation in a large patient cohort.
Methods - 444 patients with symptomatic drug-refractory paroxysmal AF (PAF, n=236 [53%]) or persistent AF (n=208) who underwent CB2-based PVI were included. The study group was divided into four groups based on the estimated glomerular filtration rate (eGFR) documented the day before the procedure. Serum creatinine levels were measured before and 48 hours after the procedure. AKI was assessed using the KDIGO guidelines.
Results - The overall incidence of AKI was 2.9% (13/444). Among the AKI group, the majority were in CKD stage 4 (2/7, 28.6%), followed by CKD stage 3 (7/111; 6.3%), CKD stage 1(1/70; 1.4%) and CKD stage 2 (3/256; 1.2%). Baseline CKD stage (HR 1.3659, 95% CI 0.05107 - 36.53, p = 0.033) was identified as independent predictor of AKI. Arterial hypertension was prevalent in the AKI group.
Conclusions - The overall incidence of postcontrast AKI in CB2-based ablation of AF was low. Cryoablation PVI is a safe therapeutic option for individuals with CKD stages 1 and 2. However, in patients with CKD stages 3 and 4, it is associated with an increased incidence of AKI.