Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Heart Vessels. 2023 Jan;38(1):77-89. doi: 10.1007/s00380-022-02124-w. Epub 2022 Jul 25.
Atrial fibrillation (AF) ablation can improve left ventricular ejection fraction (LVEF) and renal function and can even reduce mortality in patients with impaired LVEF. However, the effect of post-ablation cardiorenal dysfunction on the prognosis of patients with impaired LVEF who underwent AF ablation remains unclear. Of the 1243 consecutive patients undergoing AF ablation, the prognosis of 163 non-dialysis patients who underwent AF ablation with < 50% LVEF was evaluated. The primary outcome was a composite of all-cause mortality, heart failure hospitalization, and a need for modification of the treatment for heart failure. During the median follow-up of 4.2 years after the first AF ablation procedure, the primary outcome occurred in 30 of 163 patients (18%). The receiver operating characteristic curve analysis demonstrated that the post-LVEF (LVEF within 1 year after the procedure, and before the occurrence of primary outcome) had larger areas under the curve (0.70) than the pre-LVEF (LVEF before the procedure), and the most optimal cutoff value was LVEF ≤ 42%. Multivariate analysis demonstrated that patients with post-LVEF ≤ 42% and worsening renal function (WRF; an absolute increase in serum creatinine [SCr] ≥ 0.3 mg/dL compared with the SCr at baseline within 1 year after the procedure and before the occurrence of primary outcome) had a 3.4- to 4.3-fold and 3.4- to 3.7-fold higher risk of the primary outcome compared with those without these predictors, respectively. Patients were categorized using post-LVEF ≤ 42% and WRF as follows: group 1 (post-LVEF > 42% without WRF), group 2 (post-LVEF ≤ 42% without WRF), group 3 (post-LVEF > 42% with WRF), and group 4 (post-LVEF ≤ 42% with WRF). Group 4 had a 15.8-fold (P = 0.0001) higher risk of the primary outcome compared with group 1 after adjusting for pre-procedural factors. In patients with impaired LVEF undergoing AF ablation, post-LVEF ≤ 42% and WRF were independent predictors of poor prognosis. The combination of post-LVEF ≤ 42% and WRF is strongly associated with a poor prognosis in patients with AF undergoing ablation, who with these post-ablation cardiorenal dysfunction may have to be treated more intensively after AF ablation.
心房颤动（AF）消融术可改善左心室射血分数（LVEF）和肾功能，甚至降低射血分数降低的患者的死亡率。然而，消融术后心肾功能障碍对接受 AF 消融术且 LVEF 降低的患者的预后影响尚不清楚。在 1243 例连续接受 AF 消融术的患者中，评估了 163 例非透析患者的预后，这些患者在接受 AF 消融术后 LVEF<50%。主要终点是全因死亡率、心力衰竭住院和心力衰竭治疗修改的需要的复合终点。在首次 AF 消融术后中位 4.2 年的随访期间，163 例患者中有 30 例（18%）发生了主要终点事件。受试者工作特征曲线分析显示，术后 LVEF（术后 1 年内，在发生主要终点事件之前）的曲线下面积（AUC）大于术前 LVEF（术前），最佳截断值为 LVEF≤42%。多变量分析表明，与无 LVEF≤42%和肾功能恶化（WRF；术后 1 年内血清肌酐[SCr]较基线绝对增加≥0.3mg/dL，且在发生主要终点事件之前）的患者相比，术后 LVEF≤42%和 WRF 的患者发生主要终点事件的风险分别增加了 3.4 至 4.3 倍和 3.4 至 3.7 倍。根据术后 LVEF≤42%和 WRF 将患者分为以下几组：组 1（术后 LVEF>42%且无 WRF），组 2（术后 LVEF≤42%且无 WRF），组 3（术后 LVEF>42%且有 WRF），组 4（术后 LVEF≤42%且有 WRF）。在调整了术前因素后，与组 1 相比，组 4 发生主要终点事件的风险高 15.8 倍（P=0.0001）。在接受 AF 消融术的射血分数降低的患者中，术后 LVEF≤42%和 WRF 是预后不良的独立预测因素。AF 消融术后发生的 LVEF≤42%和 WRF 联合与预后不良密切相关，这些患者消融术后可能需要更积极地治疗心肾功能障碍。
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