Department of Cardiology, Klinikum Coburg, Germany.
J Cardiovasc Electrophysiol. 2011 Oct;22(10):1092-8. doi: 10.1111/j.1540-8167.2011.02069.x. Epub 2011 Apr 13.
No previous study has assessed the role of renal impairment in predicting the long-term risk of atrial fibrillation recurrence after cardioversion.
One hundred and fifty-nine consecutive patients with persistent atrial fibrillation undergoing successful cardioversion were enrolled. Renal function was assessed based on the estimated glomerular filtration rate (eGFR) at baseline and during follow-up. Patients were prospectively followed up for eGFR and recurrence of atrial fibrillation up to 1 year.
Patients were divided into 4 groups based upon their eGFR (group 1 >90 mL/min: 33 patients, group 2: 60-90 mL/min: 55 patients, group 3: 30-59 mL/min: 53 patients, group 4: <30 mL/min: 18 patients). Overall, 101 out of 159 (64%) patients experienced atrial fibrillation recurrence within 1 year follow-up. Atrial fibrillation recurrence was independently associated with the level of reduction of eGFR at baseline (eGFR < 30 mL/min: hazard ratio [HR] 6.82, P < 0.001; eGFR 30-59 mL/min: HR 3.31, P = 0.01; eGFR 60-90 mL/min: HR 2.10, P = 0.13; eGFR > 90 mL/min reference group). In patients with maintained sinus rhythm after 12-month follow-up eGFR was increased (8.46 ± 9.49 mL/min [range -7 to 43]), whereas patients with atrial fibrillation recurrence showed a decrease in eGFR over time (-5.75 ± 9.4 [range -32 to 25], P < 0.001).
Among a group of patients with persistent atrial fibrillation undergoing successful cardioversion, impaired renal function (based on estimated GFR) was associated with an increased risk of atrial fibrillation recurrence. Maintenance of sinus rhythm was associated with improvement in eGFR in patients with mild or moderate renal insufficiency.
此前尚无研究评估肾功能损害在预测电复律后心房颤动复发的长期风险中的作用。
连续纳入 159 例持续性心房颤动并成功电复律的患者。根据基线和随访期间的估算肾小球滤过率（eGFR）评估肾功能。前瞻性随访患者 eGFR 和心房颤动复发情况，随访时间长达 1 年。
根据 eGFR 将患者分为 4 组（组 1>90mL/min：33 例，组 2：60-90mL/min：55 例，组 3：30-59mL/min：53 例，组 4：<30mL/min：18 例）。总体而言，159 例患者中有 101 例（64%）在 1 年随访期间发生心房颤动复发。心房颤动复发与基线时 eGFR 降低水平独立相关（eGFR<30mL/min：风险比[HR]6.82，P<0.001；eGFR 30-59mL/min：HR 3.31，P=0.01；eGFR 60-90mL/min：HR 2.10，P=0.13；eGFR>90mL/min 为参考组）。在 12 个月随访后维持窦性心律的患者中 eGFR 增加（8.46±9.49mL/min[范围-7 至 43]），而心房颤动复发的患者 eGFR 随时间逐渐下降（-5.75±9.4[范围-32 至 25]，P<0.001）。
在一组成功电复律的持续性心房颤动患者中，肾功能受损（基于估算的 GFR）与心房颤动复发风险增加相关。在轻度或中度肾功能不全的患者中，维持窦性心律与 eGFR 的改善相关。
