房颤导管消融术后肾功能变化与 CHADS2 和 CHA2DS2-VASc 评分及心律失常复发相关。
Changes in renal function after catheter ablation of atrial fibrillation are associated with CHADS2 and CHA2DS2-VASc scores and arrhythmia recurrences.
机构信息
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany Centre for Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK.
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
出版信息
Heart. 2015 Jan;101(2):126-31. doi: 10.1136/heartjnl-2014-306013. Epub 2014 Oct 3.
BACKGROUND
Renal impairment is associated with poor prognosis in the setting of atrial fibrillation (AF). While AF catheter ablation is an effective treatment modality for AF burden reduction and improvement of symptoms, changes in renal function after catheter ablation and their association with rhythm outcome have not been studied in a large contemporary AF ablation cohort.
OBJECTIVE
To determine the association between CHADS2 and CHA2DS2-VASc scores and arrhythmia recurrences with changes in renal function following AF catheter ablation.
METHODS
Estimated glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation at baseline and during follow-up in 783 patients undergoing de novo AF catheter ablation. Complete rhythm follow-up was achieved in 626 patients (80%) using serial 7-day Holter ECG.
RESULTS
The study population (n=783, 61±10 years, 64% men, 57% paroxysmal AF) was followed up at median 20 (IQR 12-27) months. Baseline eGFR correlated with CHADS2 (β=-0.258, p<0.001) and CHA2DS2-VASc scores (β=-0.434, p<0.001). On multivariable analyses, eGFR changes were associated with AF recurrences (B=-0.136, p=0.014), CHADS2 (B=-0.062, p=0.035) and CHA2DS2-VASc scores (B=-0.057, p=0.003).
CONCLUSIONS
In patients after AF catheter ablation, eGFR changes during mid-term follow-up are associated with AF recurrences, CHADS2 and CHA2DS2-VASc scores.
背景
在心房颤动（AF）的情况下，肾功能损害与预后不良相关。虽然房颤导管消融是一种有效减少房颤负荷和改善症状的治疗方式，但导管消融后肾功能的变化及其与节律转归的关系尚未在大规模当代房颤消融队列中进行研究。
目的
确定 CHADS2 和 CHA2DS2-VASc 评分与房颤导管消融后肾功能变化与心律失常复发之间的关系。
方法
在 783 例接受新诊断的房颤导管消融的患者中，使用慢性肾脏病流行病学合作组方程在基线和随访期间估计肾小球滤过率（eGFR）。通过连续 7 天的 Holter ECG 在 626 例患者（80%）中实现了完整的节律随访。
结果
研究人群（n=783，61±10 岁，64%男性，57%阵发性房颤）的中位随访时间为 20 个月（IQR 12-27）。基线 eGFR 与 CHADS2（β=-0.258，p<0.001）和 CHA2DS2-VASc 评分（β=-0.434，p<0.001）相关。在多变量分析中，eGFR 变化与房颤复发（B=-0.136，p=0.014）、CHADS2（B=-0.062，p=0.035）和 CHA2DS2-VASc 评分（B=-0.057，p=0.003）相关。
结论
在房颤导管消融后的患者中，中期随访期间 eGFR 的变化与房颤复发、CHADS2 和 CHA2DS2-VASc 评分相关。
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