Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Clin Electrophysiol. 2021 Feb;7(2):174-186. doi: 10.1016/j.jacep.2020.08.018. Epub 2020 Oct 28.
This study sought to examine the impact of periprocedural acute kidney injury (AKI) in scar-related ventricular tachycardia (VT) patients undergoing radiofrequency catheter ablation (RFCA) on short- and long-term outcomes.
The clinical significance of periprocedural AKI in patients with scar-related VT undergoing RFCA has not been previously investigated.
This study included 317 consecutive patients with scar-related VT undergoing RFCA (age: 64 ± 13 years, mean left ventricular ejection fraction: 33 ± 13%, 55% ischemic cardiomyopathy). Periprocedural AKI was defined as an absolute increase in creatinine of ≥0.3 mg/dl over 48 h or an increase of >1.5× the baseline values within 1 week post-procedure.
Periprocedural AKI occurred in 31 patients (10%). Independent predictors of AKI included chronic kidney disease (odds ratio [OR]: 3.43; 95% confidence interval [CI]: 1.48 to 7.96; p = 0.004), atrial fibrillation (OR: 2.42; 95% CI: 1.01 to 5.78; p = 0.047), and peri-procedural acute hemodynamic decompensation (OR: 3.98; 95% CI: 1.17 to 13.52; p = 0.003). After a median follow-up of 39 months (interquartile range: 6 to 65 months), 95 patients (30%) died. Periprocedural AKI was associated with increased risk of early mortality (within 30 days; hazard ratio [HR]: 9.91; 95% CI: 2.87 to 34.22; p < 0.001) and late mortality (within 1 year) (HR: 4.57; 95% CI: 2.08 to 10.05; p < 0.001). After multivariable adjustment, AKI remained independently associated with increased risk of early and late mortality (HR: 4.49; 95% CI: 1.1 to 18.36; p = 0.04, and HR: 3.28; 95% CI: 1.43 to 7.49; p = 0.005, respectively).
Periprocedural AKI occurs in 10% of patients undergoing RFCA of scar-related VT and is strongly associated with increased risk of early and late post-procedural mortality.
本研究旨在探讨行射频导管消融术（RFCA）的瘢痕相关室性心动过速（VT）患者围术期急性肾损伤（AKI）对短期和长期结局的影响。
瘢痕相关 VT 行 RFCA 患者围术期 AKI 的临床意义尚未被研究过。
本研究纳入 317 例行 RFCA 的瘢痕相关 VT 连续患者（年龄：64 ± 13 岁，平均左心室射血分数：33 ± 13%，55%缺血性心肌病）。围术期 AKI 定义为术后 48 小时内肌酐绝对值增加≥0.3mg/dl，或术后 1 周内增加超过基线值的 1.5 倍。
31 名患者（10%）发生围术期 AKI。AKI 的独立预测因素包括慢性肾脏病（比值比 [OR]：3.43；95%置信区间 [CI]：1.48 至 7.96；p=0.004）、心房颤动（OR：2.42；95%CI：1.01 至 5.78；p=0.047）和围术期急性血液动力学失代偿（OR：3.98；95%CI：1.17 至 13.52；p=0.003）。中位随访 39 个月（四分位距：6 至 65 个月）后，95 名患者（30%）死亡。围术期 AKI 与早期死亡率（30 天内；风险比 [HR]：9.91；95%CI：2.87 至 34.22；p<0.001）和晚期死亡率（1 年内）（HR：4.57；95%CI：2.08 至 10.05；p<0.001）风险增加相关。多变量调整后，AKI 仍与早期和晚期死亡率风险增加独立相关（HR：4.49；95%CI：1.1 至 18.36；p=0.04，HR：3.28；95%CI：1.43 至 7.49；p=0.005）。
瘢痕相关 VT 行 RFCA 的患者中 10%发生围术期 AKI，与早期和晚期术后死亡率风险增加密切相关。
