Shin Dong Geum, Ahn Jinhee, Park Sang Hyun, Han Sang-Jin, Lim Hong Euy
Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Korean Circ J. 2024 Mar;54(3):113-123. doi: 10.4070/kcj.2023.0194. Epub 2023 Nov 14.
Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA.
A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA.
In comparison with patients without CKD (CCr >50, n=722), those with CKD (CCr ≤50, n=117) were older and predominantly female, had a lower body mass index, and showed a higher prevalence of heart failure and hypertension. Mean CHADS-VAS score was significantly higher in CKD group than in non-CKD group. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group.
ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.
既往研究报道，肾功能受损与心房颤动（AF）患者射频导管消融术后预后不良有关。然而，肾功能不全患者冷冻球囊消融（CBA）的预后尚未完全阐明。本研究旨在比较慢性肾脏病（CKD）的AF患者与无CKD的AF患者CBA的预后，并评估CBA后12个月内肾功能的变化。
前瞻性纳入839例行初发CBA的患者（65.1%为非阵发性AF [PAF]）。我们根据肌酐清除率（CCr）将患者分为两组，并进行心腔内超声心动图（ICE）引导下的无造影剂CBA。
与无CKD的患者（CCr>50，n = 722）相比，CKD患者（CCr≤50，n = 117）年龄更大，女性居多，体重指数更低，心力衰竭和高血压的患病率更高。CKD组的平均CHADS-VAS评分显著高于非CKD组。两组的手术相关并发症无显著差异。在平均25.4±11.9个月的随访期内，182例患者（21.7%）发生临床复发，两组之间无显著差异。多变量分析中，非PAF和左心房大小是AF复发的独立预测因素。CKD组在CBA后12个月内CCr水平显著改善。
在CKD的AF患者中，ICE引导下的无造影剂CBA显示出相当的长期临床疗效，且不增加手术相关并发症，同时在CBA后12个月内肾功能有所改善。
