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Relationship Between Renal Function and the Risk of Recurrent Atrial Fibrillation Following Catheter Ablation
Study Questions:
Does renal insufficiency influence the outcome of radiofrequency catheter ablation (RFCA) of paroxysmal atrial fibrillation (AF)?
Methods:
RFCA to isolate the pulmonary veins was performed in 224 patients (mean age 55 years) with paroxysmal AF. An estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 was considered indicative of chronic renal insufficiency. Serial 24-hour monitoring was performed to look for recurrent AF during a mean follow-up of 37 months.
Results:
The eGFR was <60 ml/min/1.73 m2 in 29/224 patients (13%). After a single RFCA procedure, 64% of patients had freedom from AF in the absence of antiarrhythmic drug therapy and eGFR was not an independent predictor of outcome. With redo procedures, 91% of patients had freedom from AF, and eGFR was independently associated with outcome. Recurrent AF occurred in 24% of patients with renal insufficiency compared to 6.7% of patients with a normal eGFR.
Conclusions:
Chronic renal insufficiency is an independent predictor of recurrent AF after RFCA of paroxysmal AF.
Perspective:
Chronic renal insufficiency is associated with stimulation of the renin-angiotensin-aldosterone system (RAAS). Based on prior studies demonstrating that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) lower the risk of recurrent AF, it is possible that RAAS activation predisposed to recurrent AF in the patients in this study who had renal insufficiency. This suggests that ACEIs and ARBs might improve outcomes after RFCA. Prior studies have presented conflicting results on the efficacy of these agents after RFCA of AF. However, a randomized study in patients with renal insufficiency is yet to be performed.
Keywords: Follow-Up Studies, Heart, Renin-Angiotensin System, Glomerular Filtration Rate, Catheter Ablation, Renal Insufficiency, Chronic
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