Supplementary Material for: Catheter ablation for atrial fibrillation in patients with chronic kidney disease and on dialysis – a meta-analysis and review

Background: Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with antiarrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation, if successful, may be a safer alternative. This review aims to analyse the effect of CKD or haemodialysis (HD) on recurrence of AF after catheter ablation . This review evaluates efficacy of catheter ablation therapy in CKD and haemodialysis (HD) patients by with single catheter ablation therapy. Methods: MEDLINE, and Embase, and Pubmed databases were searched until December 2020. Two authors abstracted the data independently. Relative risks were derived using random-effects meta-analysis. Results: Of the initially identified 520 782 studies, 65 and 34 observational studies on CKD and HD patients respectively were found reporting AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients have a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI 1.36-4.02, p<0.01). The heterogenicity test showed there were significant differences between individual studies (I2 = 91.0%, 95% CI 82.2%-95.6%). In a mean (SD) follow-up of 40.332.6 (20.826.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.501.21, 95% CI 0.64-2.300.84-2.67, p=0.170.55). Heterogeneity analysis showed the studies were heterogeneous (I2 90.1�.3%, 95% CI 77.5%-95.6�.8%-96.9%, p <0.01). Conclusion: Our meta-analysis suggests patients with CKD and on HD are more likely to have AF recurrences compared to AF patients who do not have CKD. However, more robust evidence from randomiszed controlled trials comparing catheter ablation and pharmaceutical rhythm therapy is urgently needed to guide therapy in this difficult to treat population.

背景：心房颤动（Atrial fibrillation, AF）在慢性肾脏病（chronic kidney disease, CKD）患者中较为高发，且由于代谢异常与不良反应增多，抗心律失常药物与抗凝治疗的应用面临较大困难。若导管消融术成功实施，则可成为更为安全的替代治疗手段。本综述旨在分析慢性肾脏病或血液透析（haemodialysis, HD）患者接受导管消融术后的心房颤动复发风险影响因素，并通过单次导管消融疗法，评估慢性肾脏病与血液透析患者的导管消融治疗疗效。
方法：检索截至2020年12月的MEDLINE、Embase及PubMed数据库文献。由两名研究者独立提取研究数据。采用随机效应Meta分析计算相对危险度（relative risks, RR）。
结果：初筛得到的520782项研究中，最终纳入65项针对慢性肾脏病患者、34项针对血液透析患者的观察性研究，均报告了心房颤动复发率。在平均（标准差）25.5（9.8）个月的随访周期内，慢性肾脏病患者的心房颤动复发风险高于非慢性肾脏病患者（RR=2.34，95%置信区间[CI]：1.36~4.02，P<0.01）。异质性检验结果显示，各研究间存在显著异质性（I²=91.0%，95%CI：82.2%~95.6%）。在平均（标准差）40.332.6 (20.826.8) 个月的随访周期内，血液透析患者的心房颤动复发风险可能高于未接受透析的健康心房颤动患者（RR 1.501.21, 95% CI 0.64-2.300.84-2.67, p=0.170.55）。异质性分析结果显示，各研究间存在显著异质性（I2 90.1�.3%, 95% CI 77.5%-95.6�.8%-96.9%, p <0.01）。
结论：本Meta分析结果显示，相较于无慢性肾脏病的心房颤动患者，慢性肾脏病患者及接受血液透析治疗的患者更易出现心房颤动复发。然而，亟需开展高质量的随机对照试验，对比导管消融术与药物节律治疗的疗效，以指导该难治性人群的临床诊疗工作。