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Management of atrial fibrillation in patients with chronic kidney disease in Europe Results of the European Heart Rhythm Association Survey

Tatjana S. Potpara, Radoslaw Lenarczyk, Torben B. Larsen, Jean-Claude Deharo, Jian Chen, Nikolaos Dagres on behalf of Conducted by the Scientific Initiatives Committee, European Heart Rhythm Association
DOI: http://dx.doi.org/10.1093/europace/euv416 1862-1867 First published online: 4 January 2016


The purpose of this European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey was to assess ‘real-world’ practice in the management of patients with atrial fibrillation (AF) and chronic kidney disease (CKD) in the European Eelectrophysiology centres. Of 41 responding centres, 39 (95.1%) and 37 (90.2%) routinely evaluated renal function in AF patients at first presentation and during follow-up, respectively, but 13 centres (31.7%) re-assessed advanced CKD only at ≥1-year intervals. While the use of oral anticoagulants (OACs) in mild-to-moderate CKD patients was mostly guided by individual patient stroke risk, 31% of the centres used no therapy, or aspirin or the left appendage occlusion in patients with advanced CKD and HAS-BLED ≥ 3. Vitamin K antagonists (VKAs) were preferred in patients with severe CKD or under renal replacement therapy (RRT), any non-VKA in patients with mild CKD, and apixaban in patients with moderate CKD. Rhythm control was preferred in patients with mild-to-moderate CKD (48.7% of centres), and rate control in patients with severe CKD (51.2% of centres). In 20 centres (48.8%), AF ablation was not performed in advanced CKD patients. Most centres performed AF ablation on OAC, but heparin bridging was still used in >10% of centres. Our survey has shown that the importance of renal function monitoring in AF patients is well recognized in clinical practice. In patients with mild-to-moderate CKD, AF is mostly managed according to the guideline recommendations, but more data are needed to guide the management of AF in patients with severe CKD or RRT.

  • Atrial fibrillation
  • Chronic kidney disease
  • Management of atrial fibrillation
  • Renal replacement therapy
  • Stroke prevention
  • Anticoagulation
  • Non-vitamin K oral anticoagulants
  • Vitamin K antagonists
  • EHRA survey
  • EP wire
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