Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Int J Clin Pract. 2021 Oct;75(10):e14173. doi: 10.1111/ijcp.14173. Epub 2021 Apr 2.
In observational studies, patients with chronic kidney disease (CKD) exhibited a controversial risk of atrial fibrillation (AF) recurrence following radiofrequency (RF) or cryoballoon ablation compared with non-CKD patients. This meta-analysis analysed the impact of CKD on AF recurrence following ablation.
We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov databases for articles published between January 1, 2010, and May 31, 2020. In total, seven observational studies with 23 468 patients were analysed. Data included demographics, AF classification, left atrial size, incidence of AF recurrence, and ablation method.
The prevalence of CKD was 8.0% (7.6%-24.4%) in the AF ablation population. The CKD population was older and had a higher prevalence of diabetes mellitus, hypertension, and heart failure, a higher CHA2DS2-VASc score, larger left atrial dimension, and lower left ventricular ejection fraction compared with the non-CKD population. The CKD patients had a higher AF recurrence rate following ablation than non-CKD patients (odds ratio [OR], 3.71; 95% confidence interval (CI), 1.35-10.19). CKD was associated with higher AF recurrent risk after ablation in patients with only paroxysmal AF (OR = 4.81, 95% CI 2.48-9.35). CKD was associated with higher AF recurrent risk in patients receiving radiofrequency ablation (OR = 3.28, 95% CI 2.17-4.94) or cryoballoon ablation (OR = 6.50, 95% CI 2.24-18.89) and in Asian region (OR = 4.86, 95% CI, 2.69-8.78).
CKD population had worse outcomes in terms of AF recurrence following RF or cryoballoon ablation.
在观察性研究中，与非慢性肾脏病（CKD）患者相比，慢性肾脏病（CKD）患者在接受射频（RF）或冷冻球囊消融后心房颤动（AF）复发的风险存在争议。本荟萃分析旨在分析 CKD 对消融后 AF 复发的影响。
我们检索了 PubMed、Embase、ProQuest、ScienceDirect、Cochrane 图书馆、ClinicalKey、Web of Science 和 ClinicalTrials.gov 数据库，以获取 2010 年 1 月 1 日至 2020 年 5 月 31 日发表的文章。共分析了 7 项包含 23468 名患者的观察性研究。数据包括人口统计学资料、AF 分类、左心房大小、AF 复发发生率和消融方法。
在 AF 消融人群中，CKD 的患病率为 8.0%（7.6%24.4%）。与非 CKD 人群相比，CKD 人群年龄较大，糖尿病、高血压和心力衰竭的患病率较高，CHA2DS2-VASc 评分较高，左心房内径较大，左心室射血分数较低。与非 CKD 患者相比，CKD 患者消融后 AF 复发率更高（比值比 [OR]，3.71；95%置信区间 [CI]，1.3510.19）。在仅阵发性 AF 患者中，CKD 与消融后 AF 复发风险升高相关（OR=4.81，95%CI 2.489.35）。在接受 RF 消融（OR=3.28，95%CI 2.174.94）或冷冻球囊消融（OR=6.50，95%CI 2.2418.89）或亚洲地区（OR=4.86，95%CI 2.698.78）的患者中，CKD 与 AF 复发风险升高相关。
在接受 RF 或冷冻球囊消融后，CKD 患者的 AF 复发风险更差。
