Five‐Year Change in the Renal Function After Catheter Ablation of Atrial Fibrillation

Abstract

BackgroundAlthough it has been reported that renal function can improve after catheter ablation of atrial fibrillation (AF), long‐term changes in renal function and its relationship to rhythm outcomes have not yet been evaluated. We explored the 5‐year change in estimated glomerular filtration rate (eGFR) in AF patients depending on medical therapy and catheter ablation.Methods and ResultsAmong 1963 patients who underwent AF catheter ablation and 14 056 with AF under medical therapy in the National Health Insurance Service database, we compared 571 with AF catheter ablation (59±10 years old, 72.3% male, and 66.5% paroxysmal AF) and 1713 with medical therapy after 1:3 propensity‐score matching. All participants had 5 years of serial eGFR data (Chronic Kidney Disease‐Epidemiology Collaboration [CKD‐EPI] method). Catheter ablation improved eGFR 5 yrs (P<0.001), but medical therapy did not. In 2284 matched patients, age (adjusted odds ratio [OR], 0.98 [0.97–0.99]; P<0.001) and AF catheter ablation (adjusted OR, 2.02 [1.67–2.46]; P<0.001) were independently associated with an improved eGFR 5 yrs. Among 571 patients who underwent AF ablation, freedom from AF/atrial tachycardia recurrence after the last AF ablation procedure was independently associated with an improved eGFR 5 yrs (adjusted OR, 1.44 [1.01–2.04]; P=0.043), especially in patients without diabetes mellitus (adjusted OR, 1.78 [1.21–2.63]; P=0.003, P for interaction=0.012). Although underlying renal dysfunction (<60 mL/min/1.73m2) was associated with atrial structural remodeling (adjusted OR, 1.05 [1.00–1.11]; P=0.046), it did not affect the AF ablation rhythm outcome.Conclusions AF catheter ablation significantly improved renal function over a 5‐year follow‐up, especially in patients maintaining sinus rhythm without preexisting diabetes mellitus.

Renal function and outcomes in atrial fibrillation patients after catheter ablation

“…We also assessed the impact of recurrent AF on renal function after AF ablation. Recurrent AF was an independent risk factor for WRF, which was in accordance with the sensitivity analysis of annual eGFR decline and previous reports by Park, et al and Kornej et al [ 6 , 7 ]. The possible mechanisms of this protective effect of sinus rhythm maintenance on renal function include elimination of AF followed by discontinuation of OAC, which may lead to reduced risks of renal hypoperfusion and micro embolism or bleeding.…”

“…Takahashi et al reported that elimination of AF by catheter ablation improved renal function over a 1-year follow-up period in AF patients with CKD [ 5 ]. Park et al, furthermore, reported that AF ablation improved 5-year renal function compared with medical therapy [ 6 ]. In addition, Kornej et al reported that eGFR change after AF ablation was associated with baseline CHA 2 DS 2 -VASc score and AF recurrences during 20 months of follow-up [ 7 ].…”

A mesh‐type flexible tip catheter vs a contact force catheter for catheter ablation of atrial fibrillation: A prospective nonrandomized 1:1 matched study

“…Well‐controlled sinus rhythm after AFCA has positive effects on the HF mortality, 1 stroke risk, 2,20 cognitive function, 4 and renal function 5 in patients with AF. However, it still poses a continuous risk for recurrence, even after AFCA 10 .…”

“…Catheter ablation of atrial fibrillation (AF) is an effective intervention for rhythm control and improves heart failure‐related mortality, 1 risk of a stroke, 2,3 cognitive function, 4 and renal function 5 . However, the long‐term AF recurrence rates after catheter ablation of atrial fibrillation (AFCA) remain substantial 6 .…”

Impact of estimated glomerular filtration rate on long-term clinical outcomes among Chinese patients with atrial fibrillation

“…In patients after AF catheter ablation, there was an inverse association between eGFR levels and AF recurrences [9]. And eliminating AF by catheter ablation was beneficial to renal function improving over a 5-year follow-up study [10].…”