Renal function after repeat catheter ablation for long-standing persistent atrial fibrillation : Low CHA2DS2-VASc score and sinus rhythm predict improved renal function.
BACKGROUND
Renal impairment and atrial fibrillation (AF) often coexist. Catheter ablation is an effective way to reduce the burden of AF and improve symptoms; however, little is known about the relationship between renal function and AF and its role in the progression of AF for patients undergoing repeat catheter ablation.


METHODS
In all, 171 patients with long-standing persistent AF ablation were enrolled in the study. The patients were divided into two groups according to their delta estimated glomerular filtration rate (eGFR) values, which was defined as the eGFR before the repeat procedure minus the eGFR before the initial procedure. Patients with decreasing eGFR (delta eGFR < 0) were categorized as group I, while individuals with no change or increasing eGFR (delta eGFR≥ 0) were categorized as group II. eGFR was estimated at baseline and at the 12-month and 24-month follow-up visits.


RESULTS
After a mean follow-up of 31.4 ± 13.2 months, group I had a significantly higher arrhythmia recurrence rate than group II (71.2 vs. 49.2 %, p < 0.001). On multivariable analyses, eGFR changes after the repeat procedure were associated with arrhythmia recurrence, hypertrophic cardiomyopathy, and CHA2DS2-VASc score. Patients with arrhythmia recurrence and those with a CHA2DS2-VASc score of ≥ 3 were more likely to show an eGFR decline at follow-up.


CONCLUSION
Patients with long-standing persistent AF, with a failed initial ablation procedure and undergoing a repeat ablation procedure, appear to have a higher risk of arrhythmia recurrence. During the follow-up period, patients without arrhythmia recurrence and those with a CHA2DS2-VASc score of < 3 show improved renal function.
['Wang|Q|Q|', 'Zhang|X-D|XD|', 'Liu|X|X|', 'Yang|Y-Q|YQ|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001281:Atrial Fibrillation D017115:Catheter Ablation D015984:Causality D002908:Chronic Disease D015897:Comorbidity D004562:Electrocardiography D005260:Female D006801:Humans D007674:Kidney Diseases D007677:Kidney Function Tests D008297:Male D008875:Middle Aged D015995:Prevalence D011379:Prognosis D018570:Risk Assessment D020521:Stroke D016896:Treatment Outcome
Renal function Repeat catheter ablation Atrial fibrillation CHA2DS2-VASc score Estimated glomerular filtration rate