Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
JACC Clin Electrophysiol. 2024 Nov;10(11):2431-2444. doi: 10.1016/j.jacep.2024.07.007. Epub 2024 Sep 4.
Atrial fibrillation (AF) is associated with impaired renal function and chronic kidney disease (CKD).
This study assessed the effects of rhythm control on renal function compared with rate control among patients recently diagnosed with AF.
A total of 20,886 patients with AF and available baseline estimated glomerular filtration rate (eGFR) data undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis in 2005 to 2015, were identified from the Korean National Health Insurance Service database. The composite outcome of ≥30% decline in eGFR, acute kidney injury, kidney failure, or death from renal or cardiovascular causes was compared with the use of propensity overlap weighting between rhythm or rate control strategies in patients with or without significant CKD (eGFR <60 mL/min/1.73 m).
Of the included patients (median age 62 years, 32.7% female), 2,213 (10.6%) had eGFR <60 mL/min/1.73 m. Among patients with significant CKD, early rhythm control, compared with rate control, was associated with a lower risk of the primary composite outcome (weighted incidence rate: 2.77 vs 3.92 per 100 person-years; weighted HR: 0.70; 95% CI: 0.52-0.95). In patients without significant CKD, there was no difference in the risk of the primary composite outcome between rhythm and rate control groups (weighted incidence rate: 3.41 vs 3.21 per 100 person-years; weighted HR: 1.06; 95% CI: 0.96-1.18). No differences in safety outcomes were found between rhythm and rate control strategies in patients without or with significant CKD.
Among patients with AF and CKD, early rhythm control was associated with lower risks of adverse renal outcomes than rate control was.
心房颤动（AF）与肾功能受损和慢性肾脏病（CKD）有关。
本研究评估了节律控制与心率控制对近期诊断为 AF 的患者肾功能的影响。
从韩国国家健康保险服务数据库中确定了 2005 年至 2015 年期间在 AF 诊断后 1 年内接受节律控制（抗心律失常药物或消融）或心率控制治疗的 20886 例有可用基线估算肾小球滤过率（eGFR）数据的 AF 患者。在有或无显著 CKD（eGFR <60 mL/min/1.73 m ）的患者中，通过倾向重叠加权比较节律或心率控制策略的使用，比较 eGFR 下降≥30%、急性肾损伤、肾衰竭或因肾脏或心血管原因死亡的复合终点。
在纳入的患者中（中位年龄 62 岁，32.7%为女性），2213 例（10.6%）eGFR <60 mL/min/1.73 m 。在有显著 CKD 的患者中，与心率控制相比，早期节律控制与较低的主要复合终点风险相关（加权发生率：2.77 与 3.92 每 100 人年；加权 HR：0.70；95%CI：0.52-0.95）。在无显著 CKD 的患者中，节律和心率控制组之间主要复合终点的风险无差异（加权发生率：3.41 与 3.21 每 100 人年；加权 HR：1.06；95%CI：0.96-1.18）。在有或无显著 CKD 的患者中，节律和心率控制策略之间在安全性结果方面没有差异。
在伴有 CKD 的 AF 患者中，早期节律控制与心率控制相比，不良肾脏结局的风险较低。
