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.