Department of Cardiovascular Medicine, Saga University.
Department of Cardiology, Saga-ken Medical Center Koseikan.
Circ J. 2020 Jul 22;84(8):1254-1260. doi: 10.1253/circj.CJ-20-0149. Epub 2020 Jul 1.
Renal dysfunction coexists with other known risk factors of left atrial (LA) structural remodeling, expressed as low-voltage zones (LVZs), and the recurrence of atrial fibrillation (AF) after ablation. This study aimed to determine whether renal dysfunction had an independent effect on the presence of LVZs and recurrence after AF ablation, using propensity score (PS) matching analysis.
448 consecutive patients who underwent their initial AF ablation were enrolled. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m, with 126 (28%) patients having CKD. Using PS matching analysis, new subsets (CKD and non-CKD group, n=103 each) were obtained, matched for age, sex, AF type, and LA volume. The presence of LVZs defined as bipolar voltage <0.5 mV was higher in the CKD group than in the non-CKD group (31% vs. 17%, P=0.034). Multivariate analysis showed eGFR was an independent predictor of the presence of LVZs (odds ratio 1.31 per 10-mL/min/1.73 mdecrease, P=0.029). AF-free survival rate was significantly lower in the CKD patients during 20±9 months of follow-up (63% vs. 82%, P=0.019), and eGFR was shown to be an independent predictor of recurrence (hazard ratio 1.29 per 10-mL/min/1.73 mdecrease, P=0.006), but the presence of LVZs did not predict recurrence.
Renal dysfunction independently predicted not only the recurrence of AF after ablation but also the presence of LVZs.
肾功能障碍与左心房（LA）结构重构的其他已知危险因素共存，表现为低电压区（LVZ），消融后心房颤动（AF）复发。本研究旨在通过倾向评分（PS）匹配分析，确定肾功能障碍对 AF 消融后 LVZ 存在和复发是否有独立影响。
共纳入 448 例接受首次 AF 消融的连续患者。慢性肾脏病（CKD）定义为估算肾小球滤过率（eGFR）<60 mL/min/1.73 m，其中 126 例（28%）患有 CKD。使用 PS 匹配分析，获得了新的亚组（CKD 和非 CKD 组，每组 103 例），年龄、性别、AF 类型和 LA 容积匹配。LVZ 定义为双极电压<0.5 mV，CKD 组高于非 CKD 组（31% vs. 17%，P=0.034）。多变量分析显示 eGFR 是 LVZ 存在的独立预测因素（每 10 mL/min/1.73 m 降低 1.31 的优势比，P=0.029）。在 20±9 个月的随访中，CKD 患者的 AF 无复发生存率明显较低（63% vs. 82%，P=0.019），并且 eGFR 是复发的独立预测因素（每 10 mL/min/1.73 m 降低 1.29 的风险比，P=0.006），但 LVZ 的存在并不能预测复发。
肾功能障碍不仅独立预测消融后 AF 的复发，而且预测 LVZ 的存在。
