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

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.

Risk factors for late recurrence in patients with nonvalvular atrial fibrillation after radiofrequency catheter ablation

“…The recurrence rate of persistent AF after CA can even reach 75% within 7 years (Rottner et al., 2020). Studies have found that the type of AF, the course of AF, alcohol consumption, and diseases such as hypertension, diabetes, and renal insufficiency will affect the therapeutic effect of CA (Anselmino et al., 2015; Pranata et al., 2020; Steinberg et al., 2014; Voskoboinik et al., 2020; Wang et al., 2014; Zheng et al., 2021). Potential modifiable risk factors, such as serum albumin concentration and hypertrophic cardiomyopathy, have yet to be explored.…”

Factors influencing early recurrence of atrial fibrillation among elderly patients following radiofrequency catheter ablation and the impact of different antiarrhythmic regimens

“…Even rare factors like anxiety have been demonstrated to be linked with it ( 23 ). Besides, other factors such as estimated glomerular filtration rate, BNP, soluble tumorigenic inhibition 2 and serum cholesterol have also been demonstrated associated with AF recurrence post-ablation ( 24–27 ). Our results were basically consistent with previous findings.…”

Atrial Fibrillation Ablation in Patients With Chronic Kidney Disease: A Review of Literature

“…The recurrence group had larger left atrial dimensions and higher LAV index (both p < 0.01) but lower kidney function (eGFR p < 0.001 and CCr p < 0.05). However, this study excluded patients with severe renal insufficiency, and the follow-up period was limited [ 47 ].…”