scholarly journals Decreased estimated glomerular filtration rate predicts long-term recurrence after catheter ablation of atrial fibrillation in mild to moderate renal insufficiency

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Zheng ◽  
Deling Zu ◽  
Keyun Cheng ◽  
Yunlong Xia ◽  
Yingxue Dong ◽  
...  

Abstract Background Catheter ablation is an established therapy for atrial fibrillation (AF), but recurrence after ablation remains a great challenge. Additionally, little is known about the effect of renal function on the efficiency of AF ablation. This study aimed to evaluate the predictors of the prognosis of catheter ablation for AF, especially the effect of renal function. Methods A total of 306 drug-refractory symptomatic patients with AF who underwent first-time catheter ablation were enrolled in the present study. Individuals underwent circumferential pulmonary vein isolation for paroxysmal AF and stepwise ablation for persistent AF. Results The follow-up time was 27.2 ± 19.5 months, 202 patients (66.01%) were free of atrial tachyarrhythmia (non-recurrence group), and the other 104 patients experienced recurrence (recurrence group). The recurrence group had a larger left atrial diameter (LAD) and left atrial volume (LAV), a higher LAV index (LAVI) (both, p < 0.01), and a lower estimated glomerular filtration rate (eGFR) (53.5 ± 14.4 vs. 65.5 ± 13.3 ml/min/1.732, p < 0.001) and creatinine clearance rate (CCr) (85.2 ± 26.1 vs. 101.5 ± 29.4 ml/min, p < 0.05). Multivariate logistic regression indicated both eGFR (p = 0.002) and LAVI (p < 0.001) as independent associated factors for long-term recurrence after single catheter ablation; multivariate Cox proportional hazard regression with backward feature selection identified both eGFR (HR: 0.93, 95% CI: 0.91–0.95, p < 0.001) and LAVI (HR: 1.32, 95% CI: 1.25–1.40, p < 0.001) as independent prognostic factors for recurrence when adjusting other clinical variables. Conclusions Decreased eGFR and elevated LAVI may facilitate the long-term recurrence of atrial tachyarrhythmia after catheter ablation for AF.

2021 ◽  
Author(s):  
Jing Zheng ◽  
De-ling Zu ◽  
Ke-yun Cheng ◽  
Yun-long Xia ◽  
Ying-xue Dong ◽  
...  

Abstract Background: Catheter ablation is an established therapy for atrial fibrillation (AF), but recurrence after ablation is still a great challenge. A higher prevalence of AF has been reported among patients with chronic renal disease. However, little is known about the effect of renal function on the efficiency of AF ablation. This study aimed to evaluate the effect of renal function on the prognosis of catheter ablation for AF. Methods: A total of 306 consecutive drug-refractory symptomatic patients with AF who underwent first-time catheter ablation were enrolled in the present study. The individuals underwent circumferential pulmonary vein isolation for paroxysmal AF and stepwise ablation for persistent AF. Results: Following up 27.2 ± 19.5 months after a single procedure, 202 patients (66.01%) were free of atrial tachyarrhythmia (non-recurrence group), and the other 104 patients experienced recurrence (recurrence group). The recurrence group had a larger left atrial diameter (LAD) and left atrial volume (LAV), a higher LAV index (LAVI) (p < 0.01, respectively), and a lower estimated glomerular filtration rate (eGFR) (53.5 ± 14.4 vs. 65.5 ± 13.3 ml/min/1.732, p < 0.001) and creatinine clearance rate (CCr) (85.2 ± 26.1 vs. 101.5 ± 29.4 ml/min, p < 0.05). Multivariate logistic analysis indicated eGFR and LAVI as independent predictors of long-term recurrence after single catheter ablation. Conclusion: Decreased eGFR and elevated LAVI may facilitate the long-term recurrence of atrial tachyarrhythmia after catheter ablation for AF.


2017 ◽  
Vol 32 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Sokratis Stoumpos ◽  
Patrick B. Mark ◽  
Emily P. McQuarrie ◽  
Jamie P. Traynor ◽  
Colin C. Geddes

Background. Severe acute kidney injury (AKI) among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who recover to normal renal function. The aim of this study was to determine the long-term renal outcome of patients experiencing AKI requiring dialysis secondary to hypoperfusion injury and/or sepsis who recovered to apparently normal renal function. Methods. All adult patients with AKI requiring dialysis in our centre between 1 January 1980 and 31 December 2010 were identified. We included patients who had estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2 12 months or later after the episode of AKI. Patients were followed up until 3 March 2015. The primary outcome was time to chronic kidney disease (CKD) (defined as eGFR persistently <60 mL/min/1.73 m2) from first dialysis for AKI. Results. Among 2922 patients with a single episode of dialysis-requiring AKI, 396 patients met the study inclusion criteria. The mean age was 49.8 (standard deviation 16.5) years and median follow-up was 7.9 [interquartile range (IQR) 4.8–12.7] years. Thirty-five (8.8%) of the patients ultimately developed CKD after a median of 5.3 (IQR 2.8–8.0) years from first dialysis for AKI giving an incidence rate of 1 per 100 person-years. Increasing age, diabetes and vascular disease were associated with higher risk of progression to CKD [adjusted hazard ratios (95% confidence interval): 1.06 (1.03, 1.09), 3.05 (1.41, 6.57) and 3.56 (1.80, 7.03), respectively]. Conclusions. Recovery from AKI necessitating in-hospital dialysis was associated with a very low risk of progression to CKD. Most of the patients who progressed to CKD had concurrent medical conditions meriting monitoring of renal function. Therefore, it seems unlikely that regular follow-up of renal function is beneficial in patients who recover to eGFR >60 mL/min/1.73 m2 by 12 months after an episode of AKI.


Hypertension ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 1205-1212 ◽  
Author(s):  
Didier Collard ◽  
Tom F. Brouwer ◽  
Rik H.G. Olde Engberink ◽  
Aeilko H. Zwinderman ◽  
Liffert Vogt ◽  
...  

2021 ◽  
Author(s):  
Tomohiro Kaneko ◽  
Eitaro Kodani ◽  
Hitomi Fujii ◽  
Risa Asai ◽  
Miyako Seki ◽  
...  

Abstract Background Various risk factors have been identified for the new-onset or rapid deterioration of chronic kidney disease. However, it is thought that many risk factors that have not yet been clarified remain. Methods Based on the results of specific annual health checkups at Tama City (n = 18,383) in 2017 and 2018, we analyzed the factors that cause new-onset chronic kidney disease and the risk factors that rapidly worsen renal function. For new-onset chronic kidney disease, proteinuria and estimated glomerular filtration rate &lt; 60 mL/min/1.73m2 were examined separately. Rapid deterioration of renal function was defined as an estimated glomerular filtration rate of ≥ 25% lower than the previous year. Results Multivariate analysis showed that, in addition to age and impaired glucose tolerance, anemia, and atrial fibrillation were risk factors for the new appearance of proteinuria. Risk factors for a decrease in estimated glomerular filtration rate &lt; 60 mL/min/1.73m2 were age and hyperuricemia. Age, systolic hypertension, urinary protein and urinary occult blood, high triglycerides, and anemia were significant risk factors for the rapid deterioration of renal function in patients with chronic kidney disease stage 3 or later. Conclusions From the results of specific annual health checkups at Tama City, atrial fibrillation, anemia, and hyperuricemia were identified as risk factors for new-onset chronic kidney disease over a short period of 1 year. Anemia was also a factor for the rapid deterioration of kidney function in subjects with renal dysfunction.


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