Cardiovascular Center, Kansai Rosai Hospital.
Circ J. 2019 Apr 25;83(5):985-990. doi: 10.1253/circj.CJ-18-1277. Epub 2019 Mar 9.
The presence of residual left atrial low-voltage areas (LVA) has been shown to be strongly associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation. A preliminary study showed that concomitant chronic kidney disease (CKD) increased the rate of AF recurrence. The association between CKD and LVA, however, has not been elucidated. In the present study, we investigated the association between CKD severity and LVA prevalence.
In total, 183 consecutive AF patients who underwent initial ablation for AF were enrolled in this retrospective observational study. Serum cystatin C before ablation was measured, and the estimated glomerular filtration rate (eGFR) was calculated. LVA were defined as sites of left atrial electrogram amplitude <0.5 mV. Of 183 patients, 76 (42%) had LVA. Patients with LVA had lower eGFR calculated using cystatin C (74±22 vs. 86±24 mL/min/1.73 m, P=0.001). The optimal cut-off of the calculated eGFR was 71.5 mL/min/1.73 m, corresponding to a 79.4% sensitivity, 50% specificity, and 67.2% predictive accuracy. LVA occurred more frequently in patients with more severe categories of CKD. On multivariate analysis, eGFR <71.5 mL/min/1.73 mwas an independent predictor of LVA (odds ratio, 3.3; 95% CI: 1.4-7.8; P=0.006).
CKD severity was correlated with left atrial LVA prevalence in patients with AF undergoing catheter ablation.
已经证明，左心房低电压区（LVA）的存在与肺静脉隔离后房颤（AF）复发密切相关。一项初步研究表明，合并慢性肾脏病（CKD）会增加 AF 复发的几率。然而，CKD 与 LVA 之间的关联尚未阐明。在本研究中，我们研究了 CKD 严重程度与 LVA 发生率之间的关系。
本回顾性观察研究共纳入 183 例因 AF 初次消融的连续 AF 患者。在消融前测量了血清胱抑素 C，计算了估算肾小球滤过率（eGFR）。LVA 定义为左心房电图幅度<0.5 mV 的部位。在 183 例患者中，76 例（42%）有 LVA。有 LVA 的患者使用胱抑素 C 计算的 eGFR 较低（74±22 与 86±24 mL/min/1.73 m，P=0.001）。计算 eGFR 的最佳截断值为 71.5 mL/min/1.73 m，对应 79.4%的灵敏度、50%的特异性和 67.2%的预测准确性。CKD 严重程度较高的患者 LVA 发生率更高。多变量分析显示，eGFR<71.5 mL/min/1.73 m 是 LVA 的独立预测因子（比值比，3.3；95%CI：1.4-7.8；P=0.006）。
在接受导管消融的 AF 患者中，CKD 严重程度与左心房 LVA 发生率相关。
