Cambridge University, Cambridge, United Kingdom.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Cardiorenal Med. 2021;11(1):27-32. doi: 10.1159/000507566. Epub 2020 Dec 9.
Emerging data suggest that cardioversion for atrial fibrillation (AF) may be associated with acute kidney injury (AKI). However, limited data are available regarding the incidence and risk factors for AKI after direct current cardioversion (DCCV) of AF.
All patients undergoing DCCV at Mayo Clinic between 2001 and 2012 for AF were prospectively enrolled in a database. All patients with serum creatinine (SCR) values pre- and post-cardioversion were reviewed for AKI, defined as a ≥25% decline in eGFR (estimated glomerular filtration rate) from baseline value within 7 days of the DCCV.
Of the 6,427 eligible patients, 1,256 (19.5%) patients had pre- and post-DCCV SCR available and formed the cohort under study. The mean age was 70.4 (SD 11.7) years, and 67.3% were male. During the study period, 131 (10.4%) patients suffered from AKI following DCCV. AKI was independently associated with inpatient status (OR 26.79; 95% CI 3.69-194.52), CHA2DS2-VASc score (OR 1.25; 95% CI 1.11-1.41), prior use of diuretics (OR 1.59; 95% CI 1.03-2.46), and absence of CKD (OR 1.61; 95% CI 1.04-2.49), and was independent of the success of the DCCV. None of the patients required acute dialysis during the study outcome period.
AKI following DCCV of AF is common, self-limited, and without the need for replacement therapies.
新出现的数据表明，房颤（AF）的电复律可能与急性肾损伤（AKI）有关。然而，关于 AF 直流电复律（DCCV）后 AKI 的发生率和危险因素的数据有限。
2001 年至 2012 年间，在梅奥诊所接受 DCCV 治疗的所有 AF 患者均前瞻性地纳入数据库。所有 DCCV 前后血清肌酐（SCR）值的患者均接受 AKI 评估，定义为 DCCV 后 7 天内 eGFR（估算肾小球滤过率）从基线值下降≥25%。
在 6427 名合格患者中，有 1256 名（19.5%）患者 DCCV 前后的 SCR 值可用，形成了研究队列。平均年龄为 70.4（SD 11.7）岁，67.3%为男性。研究期间，131 名（10.4%）患者在 DCCV 后发生 AKI。AKI 与住院状态（OR 26.79；95%CI 3.69-194.52）、CHA2DS2-VASc 评分（OR 1.25；95%CI 1.11-1.41）、利尿剂的使用（OR 1.59；95%CI 1.03-2.46）和 CKD 缺失（OR 1.61；95%CI 1.04-2.49）独立相关，且与 DCCV 的成功无关。在研究结果期间，没有患者需要急性透析。
AF 的 DCCV 后 AKI 很常见，是自限性的，不需要替代治疗。
