Renal function and outcomes after catheter ablation of patients with atrial fibrillation: The Guangzhou atrial fibrillation ablation registry; [Fonction rénale et évènement au décours d'une ablation par cathéter de fibrillation atriale: The Guangzhou atrial fibrillation ablation registry]

Abstract

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