# Safety and efficacy of atrial fibrillation ablation in kidney transplant patients

## TL;DR

Ablation for atrial fibrillation is safe and effective in kidney transplant patients, with outcomes similar to non-transplant patients.

## Contribution

This study provides the first prospective data on catheter ablation safety and efficacy in kidney transplant patients.

## Key findings

- Ablation success rate was 100% in kidney transplant patients.
- AF recurrence-free rates at 18 months were similar between transplant and control groups.
- Kidney function remained stable after ablation in transplant patients.

## Abstract

Managing atrial fibrillation in kidney transplant patients poses a challenge for both nephrologists and cardiologists. Data regarding the safety and efficacy of catheter ablation in this patient’s cohort is scarce.

In this two-center prospective study, we included all consecutive kidney transplant patients who underwent atrial fibrillation ablation between April 2017 and March 2022. A 1:3 propensity score matching created a control group of non-transplant AF patients undergoing ablation. We included 16 kidney transplant patients and 48 matched controls. Ablation was successful in all patients. The periprocedural complication rate (6.3% in the kidney transplant group vs. 6.3% in the control group, p value = 1) did not differ between the two groups. One transplant patient experienced graft dysfunction after a complication. At 18 months, AF recurrence-fee rates were 69% in the transplant group and 70.1% in controls (p = 0.95). By the last follow-up, all transplant patients had discontinued antiarrhythmic drugs, while 19.6% of the patients in the control group were treated with antiarrhythmic drugs (p = 0.09). Kidney function in the transplant group remained stable (eGFR 32 [23.8, 40.5] ml/min/1.73 m2 before vs. 34 [29.8, 38] ml/min/1.73 m2 at last follow up, p = 0.93).

This study demonstrates that catheter ablation is a viable option for treating AF in kidney transplant patients, with comparable outcomes to non-transplanted individuals. Discontinuing antiarrhythmic drugs reduces drug interaction risks, but minimizing procedural complications remains critical to preserving graft function.

The online version contains supplementary material available at 10.1007/s10840-025-02006-x.