The Incidence and Prognosis of Renal Dysfunction following Cardioversion of Atrial Fibrillation

Abstract

Objective: Limited data are available regarding the incidence and clinical impact of renal dysfunction following cardioversion of atrial fibrillation. The objective of this study was to assess the incidence and implications of renal dysfunction following cardioversion of atrial fibrillation. Methods: We conducted a nested case-control study to determine the incidence, timing, risk factors and outcome of atrial fibrillation cardioversion associated with renal dysfunction (AFCARD) in a tertiary medical center. Consecutive patients undergoing direct current cardioversion (DCCV) for atrial fibrillation in our institution during 2008-2009 with measurements of creatinine before and following cardioversion were included. AFCARD was defined as a rise in serum creatinine greater than 25% from baseline within a week following DCCV. Results: One hundred and twelve patients were included in the study, of whom 19 (17%) developed AFCARD. One patient required hemodialysis. Patients with AFCARD had a higher incidence of advanced heart failure, diabetes mellitus and were more frequently treated with digoxin and enoxaparin. Patients with AFCARD had a significantly decreased survival rate at 1 year (63 vs. 92%; p < 0.001). Conclusions: AFCARD is relatively common and is associated with increased mortality. These findings suggest a role for close surveillance of renal function following DCCV.

National Trends and Impact of Acute Kidney Injury Requiring Hemodialysis in Hospitalizations With Atrial Fibrillation

“…The data on AKI-D in AF hospitalizations are limited because studies looking at AF and AKI-D have been only small single-center observational studies. 12,13 Our finding of increasing incidence of AKI-D in the AF population coincides with the results of a recent study in the general population that found that the incidence of AKI-D is increasing with an unadjusted average increase of 10% per year; however, patient demographic and comorbidities seemed to account for the temporal trends in the general population. 20,21 In our analysis even after adjustment for multiple similar covariates, there remained an unexplained 3% increase in AKI-D per year.…”

“…An analysis of the Nationwide Inpatient Sample demonstrated that admissions for AF complicated by AKI were associated with nearly double the odds of mortality. 11 However, few studies have examined the association between AF and AKI-D. 12 Most of these studies evaluate the concurrent occurrence of AF and AKI after cardiac surgery and not in patients admitted with a primary diagnosis of AF. 13 In order to address this knowledge gap, we utilized a large, nationally representative database to estimate the secular temporal trends of the incidence of AKI-D among adults hospitalized with AF.…”

A Cardioversion and Renal Dysfunction Cascade: Cardioversion for Atrial Fibrillation, Acute Kidney Injury, and Recurrence of Atrial Fibrillation

“…However, renal dysfunction post-DCCV (otherwise called post cardioversion renal failure) is less well described. In a recent study in 2013 evaluating the incidence and prognosis of renal dysfunction following cardioversion of atrial defibrillation, 17% of patients were reported to have developed AFCARD [1]. In another prospective study published in 2018 at the Mayo Clinic, the incidence was 5.7% [2].…”

“…Renal dysfunction following direct current cardioversion (DCCV) for atrial fibrillation (AF) is a recognized complication following cardioversion for atrial fibrillation and presents with an interval worsening of renal function [1]. Post-cardioversion renal failure is heralded by renal hypoperfusion which then results in a rise in serum creatinine [2,3].…”

Risk of Kidney Injury following Cardioversion for Atrial Fibrillation

“…The recent paper of Hellman et al [18], published in the latest issue of Cardiology , addresses this gap in our knowledge. Of 112 patients with AF and normal or borderline kidney function who underwent DCCV, the primary outcome of worsening kidney function was identified in 19.…”