Browsing by Author "Guo, Pi (54883201600)"

Introduction: Chronic kidney disease (CKD) has been associated with incident atrial fibrillation (AF) and its complications, but data from Asian cohorts are limited. Aim: To explore the relationship of AF recurrence after catheter ablation (CA) with eGFR as a continuous variable, and with different renal function categories (normal: estimated glomerular filtration rate [eGFR] ≥90 mL/min/1.73 m2; mild CKD: eGFR 60–89 mL/min/1.73 m2; moderate CKD: eGFR 45–59 mL/min/1.73 m2; severe CKD: <45 mL/min/1.73 m2), using data from the Guangzhou Atrial Fibrillation Ablation Registry. Methods: We studied consecutive symptomatic adult patients with non-valvular AF, refractory to at least one antiarrhythmic drug and eligible for CA, in Guangdong General Hospital between June 2011 and August 2015. Results: Data were available from 1407 consecutive patients (mean age 57.3 ± 11.5 years; 68% men) with non-valvular AF undergoing radiofrequency or cryoballoon ablation. During a mean follow-up of 20.7 ± 8.8 months, 18.6% of patients with paroxysmal AF and 50.5% with non-paroxysmal AF had AF recurrence. On multivariable analysis, eGFR (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.96–0.97) was an independent risk factor for AF recurrence, with a good predictive value (area under the curve 0.74, 95% CI 0.72–0.77; P < 0.01). In the normal renal function, and mild, moderate and severe CKD categories, AF recurrence rates were 11.5%, 29.3%, 72.0% and 93.3%, respectively. Compared with normal renal function, there were stepwise increased risks of AF recurrence with mild CKD (HR 3.30, 95% CI 2.55–4.26; P < 0.01), moderate CKD (HR 9.43, 95% CI 6.76–13.16; P < 0.01) and severe CKD (HR 12.35, 95% CI 6.93–21.99; P < 0.01). Conclusions: In a large cohort of Asian patients with AF, renal dysfunction increased the risk of AF recurrence after CA. AF recurrence gradually increased with worsening kidney function in this cohort. © 2019 Elsevier Masson SAS

Background: Female sex has been linked with worse prognosis in patients with atrial fibrillation (AF). Clinical risk stratification of women with AF may help decision-making before catheter ablation (CA). Aim: To evaluate arrhythmia outcomes and the predictive value of clinical scores for arrhythmia recurrence in a large cohort of Chinese patients with AF undergoing CA. Methods: A total 1410 of patients (68.1% men) who underwent AF ablation with scheduled follow-up were analysed retrospectively. Baseline characteristics and ablation outcome were compared between men and women. The predictive values of risk scoring systems for AF recurrence were assessed in women. Results: Recurrence, early recurrence and complications after CA were similar in women and men over similar follow-up periods (20.7 ± 8.0 vs 20.7 ± 9.1 months; P > 0.05). Compared with men, women with AF recurrence were older and had a larger left atrial diameter (LAD), less paroxysmal AF, lower left ventricular ejection fraction, lower estimated glomerular filtration rate (eGFR) and higher serum concentrations of B-type natriuretic peptide (BNP) and C-reactive protein (CRP) (all P < 0.01). Multivariable analysis showed that age, non-paroxysmal AF, body mass index, coronary artery disease, LAD, early recurrence, eGFR, BNP and CRP were independent risk factors with sex differences (all P < 0.05) in the whole cohort. In women, only non-paroxysmal AF, early recurrence, BNP, CRP (all P < 0.01) and history of stroke/transient ischaemic attack (P = 0.016) were independent risk factors. Of the clinical scoring systems tested, MB-LATER, APPLE, CAAP-AF and BASE-AF 2 scores (C-indexes 0.73, 0.72, 0.68 and 0.72, respectively; all P < 0.01) had a modest predictive value for AF recurrence after CA in women. Conclusions: CA for AF has similar recurrence risks in women and men, but there are sex differences in the clinical characteristics and risk factors associated with AF recurrence. © 2019 Elsevier Masson SAS