Multicenter Experience of Catheter Ablation for Atrial Fibrillation in Sickle Cell Anemia.

Abstract

Introduction: Adult patients with sickle cell anemia (SCA) are at high risk for atrial arrhythmias; however, data on the outcomes of atrial fibrillation (AF) ablation in this population are scarce.

Methods and results: Eight consecutive SCA patients undergoing AF ablation in three tertiary ablation centers were retrospectively included (6 males, mean age 46 ± 9 years). Patients exhibited severe left atrial (LA) remodeling (mean indexed LA volume 71 ± 14 mL/m²) and six presented with persistent AF. Ablation techniques included radiofrequency (RF, n = 6), cryoballoon (n = 1), and pulsed-field ablation (PFA, n = 1). Three patients received additional LA lesions beyond pulmonary vein isolation. At 12 months, seven patients (88%) were free from any atrial arrhythmia, with 88% off antiarrhythmic therapy, and NYHA class significantly improved from 2.00 ± 0.93 to 1.38 ± 0.52 (p = 0.049). No major complications were reported following RF ablations. The cryoballoon case was complicated by an acute chest syndrome, while moderate hemolysis occurred following PFA, without clinical consequence.

Conclusion: AF catheter ablation appears effective in SCA patients. While RF ablation showed a reassuring safety profile, specific risks associated with cryoballoon and PFA warrant further investigation.