Abbo Aharon Ronnie, Arow Ziad, Eyal Allon, Glueck Robert M, Elias Adi, Beinart Roy, Nof Eyal, Haskiah Feras, Michowitz Yoav, Glikson Michael, Konstantino Yuval, Haim Moti, Luria David, Omelchenko Alexander, Cohen-Hagai Keren, Shehab Maysam, Marai Ibrahim, Laish-Farkash Avishag, Suleiman Mahmoud
Cardiology Department, Rambam Health Care Campus, Haifa 3109601, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel.
J Clin Med. 2025 Sep 3;14(17):6227. doi: 10.3390/jcm14176227.
Limited and inconsistent information exist about how kidney function affects the outcomes of ablation procedures in patients with atrial fibrillation (AF). Therefore, the aim of this study was to investigate the effectiveness and safety of AF ablation in a large national study across groups classified by varying levels of estimated glomerular filtration rates (eGFRs). The Israeli Catheter Ablation Registry (ICAR) is a prospective, multicenter cohort that includes patients who underwent pulmonary vein isolation (PVI) during the years 2019-2021 for the treatment of AF. Primary study endpoints were the recurrence of AF and the need for repeat ablation at 12 months. Secondary endpoints were rehospitalization and procedural complications after AF ablation. Between January 2019 and December 2021, 1002 AF patients underwent PVI. Baseline creatinine was available in 929 patients, which comprised the study cohort. Of these patients, 226 (24%) had preserved eGFR (>90 mL/min/1.73 m), 511 (55%) had mildly reduced eGFR (60-89 mL/min/1.73 m), and 192 (21%) had moderately to severely reduced eGFR (<59 mL/min/1.73 m). Patients with moderately to severely reduced eGFR were generally older and more likely to be female. There were no clinically meaningful differences in the use of antiarrhythmic medications among the eGFR groups, either before or after PVI. There were no significant differences in 12-month AF recurrence rates among the three study groups: 30%, 32%, and 40% in patients with preserved eGFR, mild, and moderately to severely reduced eGFR, respectively ( = 0.1). The one-year rehospitalization rate was higher in patients with moderately to severely reduced eGFR: 19%, 24%, and 32% in patients with preserved eGFR, mild, and moderately to severely reduced eGFR, respectively ( = 0.01). Periprocedural complications were infrequent across all the eGFR groups. Patients with an eGFR of <30 mL/min/1.73 m were underrepresented (<1%), limiting applicability to this group. PVI is a safe and effective procedure that should be considered for CKD patients with AF who are deemed as suitable for the intervention, even in the presence of declined eGFR values. Future studies are still needed to evaluate the safety and effectiveness of the procedure in individuals with severely reduced eGFR or end-stage kidney disease.
关于肾功能如何影响心房颤动（AF）患者消融手术的结果，现有信息有限且不一致。因此，本研究的目的是在一项全国性大型研究中，调查按估算肾小球滤过率（eGFR）不同水平分类的各组患者中AF消融的有效性和安全性。以色列导管消融注册研究（ICAR）是一项前瞻性多中心队列研究，纳入了2019年至2021年期间接受肺静脉隔离（PVI）治疗AF的患者。主要研究终点是AF复发和12个月时重复消融的必要性。次要终点是AF消融后的再次住院和手术并发症。2019年1月至2021年12月期间，1002例AF患者接受了PVI。929例患者有基线肌酐数据，构成研究队列。在这些患者中，226例（24%）eGFR保留（>90 mL/min/1.73 m²），511例（55%）eGFR轻度降低（60 - 89 mL/min/1.73 m²），192例（21%）eGFR中度至重度降低（<59 mL/min/1.73 m²）。eGFR中度至重度降低的患者通常年龄较大，女性更常见。在PVI前后，eGFR组间抗心律失常药物的使用在临床上无显著差异。三个研究组的12个月AF复发率无显著差异：eGFR保留、轻度降低和中度至重度降低的患者分别为30%、32%和40%（P = 0.1）。eGFR中度至重度降低的患者一年再次住院率更高：eGFR保留、轻度降低和中度至重度降低的患者分别为19%、24%和32%（P = 0.01）。所有eGFR组围手术期并发症均不常见。eGFR<30 mL/min/1.73 m²的患者代表性不足（<1%），限制了该组的适用性。PVI是一种安全有效的手术，对于被认为适合该干预的AF合并慢性肾脏病患者应予以考虑，即使存在eGFR值下降。未来仍需研究评估该手术在eGFR严重降低或终末期肾病患者中的安全性和有效性。
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