Background
We sought to study longer term survival in patients with aortic stenosis (
AS
) and nondialysis chronic kidney disease (
CKD
).
Methods and Results
We studied 839 patients (aged 78±9 years and 51% male) with
CKD
and
AS
on echocardiogram from 2005 to 2012. Longer term all‐cause and cardiovascular mortality was compared with a
CKD
group without
AS
, propensity matched for age, sex, race, left ventricular ejection fraction and
CKD
stage. Cox models were used to evaluate all‐cause mortality and competing‐risks regression models censored at time of aortic valve replacement to evaluate cardiac mortality in patients with
AS
and
CKD
. Overall, 511 (61%), 252 (30%), and 76 (9%) patients had
CKD
stages 3a, 3b, and 4, respectively; 93% had hypertension, 28% had diabetes mellitus, and 37% had coronary artery disease. In total, 185 (22%) had mild AS, 355 (42%) had moderate AS, and 299 (36%) had severe
AS
(66 symptomatic). Patients with
CKD
and
AS
had higher cardiac and all‐cause mortality compared with controls with
CKD
and no
AS
(
P
<0.001). Among patients with
AS
and
CKD
, there were 156 (19%) aortic valve replacements and 454 (54%) deaths (203 cardiac deaths) at 4.0±2.3 years of follow‐up. Lower estimated glomerular filtration rate (hazard ratio per 10 mL/min per 1.73 m
2
: 1.18; 95% CI, 1.08–1.29) was associated with increased risk of all‐cause mortality but not cardiac mortality (hazard ratio: 1.12; 95% CI, 0.97–1.30;
P
=0.13). Of patients undergoing aortic valve replacement, 61% had improvement in estimated glomerular filtration rate within 1 year (median percentage change=+2.8% per month).
Conclusions
Among patients with nondialysis
CKD
,
AS
is associated with significantly higher cardiac and all‐cause mortality; lower estimated glomerular filtration rate is associated with increased mortality, and aortic valve replacement was associated with improved survival.
Among our patients, almost all cancers occurred in native lung in ex-smokers who received a lung transplant for COPD. The cancer was often an incidental finding on a routine chest radiograph; however, the disease was usually at an advanced stage at diagnosis, limiting therapeutic options.
BACKGROUND:Atrial fibrillation recurrence after initial long-term success of catheter ablation has been described, yet not well studied. We assessed the electrophysiological findings and outcomes of repeat ablation procedures in this setting.
METHODS AND RESULTS:Between 2000 and 2015, 10 378 patients underwent atrial fibrillation ablation and were enrolled in a prospectively maintained data registry. From this registry, we included all 137 consecutive patients who had initial long-term success, defined as freedom from recurrent arrhythmia for >36 months off antiarrhythmics, then underwent repeat ablation for recurrent atrial fibrillation. The median arrhythmia-free period that defined long-term success was 52 months (41-68 months). In redo ablations, reconnection along at least one of the pulmonary veins (PVs) was found in 111 (81%) patients. Reconnection along a left superior, left inferior, right superior, and right inferior PV was found in 64%, 62%, 50%, and 54% of patients, respectively, and were reisolated. Additional non-PV ablations were performed in 127 (92.7%) patients: posterior wall (46%), septal to right PVs (49%), superior vena cava (35%), roof lines (52%), and cavotricuspid isthmus (33%). After a median follow-up of 17 months (5-36.9 months), 103 patients (75%) were arrhythmia free (79 off antiarrhythmics, 24 on antiarrhythmics).
CONCLUSIONS:PV reconnection is the most common electrophysiological finding in patients with atrial fibrillation recurrence after long-term success, but with lower rates than what had been reported for early recurrences. In our experience, repeat ablations in this setting involve complex ablation approaches to reisolate the PVs and modify the atrial substrate and are associated with good success rates.
In patients with cardiac implantable electronic device infection, dialysis status did not seem to add complexity to transvenous lead extraction but was independently associated with increased mortality at 1 and 6 months.
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