Department of Cardiology, Ryorei Memorial Kyoto Hospital, Kyoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
PLoS One. 2020 Nov 9;15(11):e0241449. doi: 10.1371/journal.pone.0241449. eCollection 2020.
Atrial fibrillation (AF) and renal failure coexist and interact. However, scarce data about association between renal function and clinical outcomes in patients undergoing catheter ablation for AF are available. We sought to evaluate long-term renal function and clinical outcomes after AF ablation.
We enrolled 791 non-dialysis patients undergoing catheter ablation for AF, and evaluated the incidence of worsening renal function (WRF) after the procedure, defined as >30% decline in estimate glomerular filtration rate.
Mean follow-up duration was 5.1±2.5 years. Five hundreds and twenty-six patients (66.5%) were free from recurrent atrial arrhythmias without any antiarrhythmic drugs at the time of final follow-up. Cumulative incidence of WRF was 13.2% at 5-year after procedure, which was significantly higher in patients with recurrent AF compared to those without (21.6% versus 8.7%, P<0.001). In the multivariable analysis, recurrent AF was an independent risk factor for WRF (adjusted hazard ratio [HR] 1.89, 95% confidence interval 1.27-2.81, P = 0.002), along with congestive heart failure, diabetes, and eGFR <60 ml/min/1.73m2 at baseline. Patients with WRF had significantly higher 5-year incidences of all-cause death, cardiovascular death, heart failure hospitalization, ischemic stroke, and major bleeding compared to those without WRF. After adjustment of baseline differences in the multivariate Cox model, the excessive risks of WRF for all-cause death and heart failure hospitalization remained significant (adjusted HR 3.46, P = 0.002; adjusted HR 3.67, P<0.001).
In AF patients undergoing catheter ablation for AF, arrhythmia recurrence was associated with WRF during follow-up, which was a strong predictor of adverse clinical outcomes.
心房颤动（AF）和肾功能衰竭并存且相互影响。然而，关于接受导管消融治疗 AF 的患者肾功能与临床结局之间的关联，相关数据却十分匮乏。我们旨在评估 AF 消融术后患者的长期肾功能和临床结局。
我们纳入了 791 名接受导管消融治疗 AF 的非透析患者，并评估了术后肾功能恶化（WRF）的发生率，定义为估算肾小球滤过率（eGFR）下降>30%。
平均随访时间为 5.1±2.5 年。526 名（66.5%）患者在最终随访时无需任何抗心律失常药物即可无复发性心房颤动。术后 5 年时，WRF 的累积发生率为 13.2%，与无复发性 AF 患者相比，WRF 发生率明显更高（21.6%比 8.7%，P<0.001）。在多变量分析中，复发性 AF 是 WRF 的独立危险因素（校正后的危险比[HR] 1.89，95%置信区间 1.27-2.81，P = 0.002），此外，充血性心力衰竭、糖尿病和 eGFR <60 ml/min/1.73m2 也是基线时的独立危险因素。与无 WRF 患者相比，WRF 患者在 5 年内发生全因死亡、心血管死亡、心力衰竭住院、缺血性卒中和大出血的风险明显更高。在多变量 Cox 模型中调整基线差异后，WRF 导致全因死亡和心力衰竭住院的风险过高仍具有显著意义（校正 HR 3.46，P = 0.002；校正 HR 3.67，P<0.001）。
在接受导管消融治疗 AF 的 AF 患者中，随访期间的心律失常复发与 WRF 相关，WRF 是不良临床结局的强有力预测因子。
