Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation

Li, Min; Liu, Tong; Luo, Di; Li, Guangping

doi:10.5603/cj.a2013.0116

Cited by 37 publications

(25 citation statements)

References 26 publications

(53 reference statements)

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“…In 3 studies, kidney dysfunction was an independent predictor of AF recurrence upon ECG or Holter recordings conducted at 3‐month intervals . A meta‐analysis combining these data reported a significant association between an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m 2 and AF recurrence with at least 1 year of follow‐up (pooled HR: 2.32, 95%CI: 1.61–3.35, P < 0.001) . Another study examining 702 ablation recipients reported an association between CKD and AF recurrence using a cutpoint of eGFR <68 mL/min/1.73m 2 (HR: 1.43, 95%CI: 1.05–1.95, P = 0.007) .…”

Section: Discussionmentioning

confidence: 99%

Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease

Ullal

Kaiser

Fan

et al. 2016

Cardiovasc electrophysiol

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INTRODUCTION Data regarding catheter ablation of atrial fibrillation (AF) in patients with chronic kidney disease (CKD) is limited. We therefore assessed the association of CKD with common safety and clinical outcomes in a nationwide sample of ablation recipients. METHODS Using MarketScan® Commercial Claims and Medicare Supplemental Databases, we evaluated 30-day safety and 1-year clinical outcomes in patients who underwent a first AF ablation procedure between 2007–2011. We calculated frequency of common 30-day complications and calculated frequencies, incidence rates, and Cox proportional hazards for outcomes at 1 year post-ablation. RESULTS Of 21,091 patients included, 1,593 (7.6%) had CKD. Patients with CKD were older (64 vs 59 years, p<0.001) with higher CHA2DS2-VASc scores (3.2 vs 1.8, p<0.001). At 30 days post-ablation, patients with CKD had similar rates of stroke/TIA (0.13% vs 0.13%, p=0.99), perforation/tamponade (3.2% vs 3.1%, p=0.83), and vascular complications (2.4% vs 2.2%, p=0.59) as patients without CKD, but were more likely to be hospitalized for heart failure (2.1% vs. 0.4%, p<0.001). In multivariate analysis, there were no significant differences in hazards of AF hospitalization (adjusted HR: 1.02, 95%CI: 0.87–1.20), cardioversion (adjusted HR: 0.99, 95%CI: 0.87–1.12), or repeat AF ablation (adjusted HR: 0.89, 95%CI: 0.76–1.06) at one year. CONCLUSIONS Among patients selected for AF ablation, those with and without CKD had similar rates of post-procedural complications although they were more likely to be re-admitted for heart failure. CKD was not independently associated with AF hospitalization, cardioversion, and repeat ablation. These findings can inform clinical decision-making in patients with AF and CKD.

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Section: Discussionmentioning

confidence: 99%

Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease

Ullal

Kaiser

Fan

et al. 2016

Cardiovasc electrophysiol

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“…To analyze the P wave during sinus rhythm preceding the new-onset AF episode, 101 patients who had sinus rhythm ECG recordings within 12 months before the new-onset AF episode were selected. In addition, to enable the evaluation of cardiac Vol 55 No 5 PREDICTION OF NEW-ONSET AF VIA P WAVE ANALYSIS structural changes at this point in each patient, 68 patients who had echocardiographic recordings within 12 months before the AF episode were selected as the study population ( Figure 1). As the control population, 332 patients without AF episodes who had ECG recordings in the same period of this study were randomly selected from the digital ECG profiling system of Kitasato University Hospital.…”

Section: Methodsmentioning

confidence: 99%

“…Even when considering catheter ablation for AF, it is important to detect the early or precursor state of AF in clinical cases because the effect of catheter ablation is higher in patients with earlier-stage AF, even in those with simple circumference ablation of pulmonary veins. [5][6][7] The arrhythmogenic substrate of AF is known to be constructed progressively under various pathological conditions, including AF itself; [7][8][9][10][11] therefore, it could be speculated that the electrophysiological properties of the atrium may be modified in its precursor state. Several studies have attempted to identify the changes in P waves during sinus rhythm in AF patients.…”

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confidence: 99%

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Yoshizawa

Niwano

et al. 2014

Int. Heart J.

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SummaryIt is unknown whether 12-lead ECG can predict new-onset AF. In the present study, we identified patients with new onset AF from our digitally stored ECG database, and the P wave morphologies were analyzed in their preceding sinus rhythm recordings as the precursor state for AF. The P wave was analyzed in the most recent ECG recording of sinus rhythm preceding new onset AF within 12 months. The duration and amplitude of P waves were analyzed in 12 leads and compared between the 2 groups with the other clinical parameters. The study population consisted of 68 patients with new-onset AF and 68 age and sex-matched controls. Multivariate analysis revealed that the P wave amplitude in leads II and V 1 (0.157 ± 0.056 versus 0.115 ± 0.057 mV, P = 0.032, and 0.146 ± 0.089 versus 0.095 ± 0.036 mV, P = 0.002) and P wave dispersion (56.9 ± 14.8 versus 33.5 ± 12.9 ms, P = 0.001) were significant independent factors for the prediction of new-onset AF. By using these factors, new-onset AF could be predicted with a sensitivity of 69.1% and specificity of 88.2%. P wave analysis is useful for predicting new onset AF. (Int Heart J 2014; 55: 422-427) Key words: P wave dispersion, P wave duration, Atrial remodeling A lthough several experimental studies predicted a preventive effect of upstream therapies for atrial fibrillation (AF) using angiotensin receptor blockades (ARBs), 1,2) recent clinical trials of such upstream therapies have failed to demonstrate their preventive effect in clinical cases. The reason for this discrepancy is unclear; however, it may be partly explained by the heterogeneity of the pathogenic conditions of AF in clinical cases.3,4) Because a meta-analysis of ARB studies 2) has suggested a possible effect of ARB in the prevention of new-onset AF in clinical cases, upstream therapy may possibly exhibit an effect if it could be performed in the precursor state of AF. Even when considering catheter ablation for AF, it is important to detect the early or precursor state of AF in clinical cases because the effect of catheter ablation is higher in patients with earlier-stage AF, even in those with simple circumference ablation of pulmonary veins.5-7) The arrhythmogenic substrate of AF is known to be constructed progressively under various pathological conditions, including AF itself; 7-11) therefore, it could be speculated that the electrophysiological properties of the atrium may be modified in its precursor state. Several studies have attempted to identify the changes in P waves during sinus rhythm in AF patients. 7,8,[12][13][14][15][16] In these reports, prolongation of the P wave duration or expansion of the dispersion of the P wave duration in the surface 12-lead electrocardiogram (ECG) have been focused on as indices for identification of AF patients. [10][11][12][13][14][15] In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital, and P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-on...

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“…There is also a wide spectrum of patients with CKD, and whether patients with more advanced CKD got AF ablation is not clear. Systematic reviews and other studies have suggested higher recurrence after AF ablations in patients with CKD . The authors do look at important endpoints such as repeat procedures, cardioversions, or hospitalizations; however, we have to accept that recurrence of AF by monitoring in this study cannot be assessed, which is a major flaw.…”

Section: Is Af Ablation the Same In Patients With Ckd?mentioning

confidence: 98%

Outcomes of Atrial Fibrillation Ablation in Patients With and Without Chronic Kidney Disease Are No Different…. . Hmmm!

Deshmukh

Kancharla

2016

Cardiovasc electrophysiol

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Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation

Abstract: (Cardiol J 2014; 21, 1: 89-95)

Cited by 37 publications

References 26 publications

Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease

Safety and Clinical Outcomes of Catheter Ablation of Atrial Fibrillation in Patients With Chronic Kidney Disease

Prediction of New Onset Atrial Fibrillation Through P Wave Analysis in 12 Lead ECG

Outcomes of Atrial Fibrillation Ablation in Patients With and Without Chronic Kidney Disease Are No Different…. . Hmmm!

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