Results
A total of 132 AF patients with mild renal dysfunction were included in
this study. Table 1 summarizes the clinical characteristics at baseline
during the initial admission. Among all the patients, 66.7% were men (n
= 88), and 54.5% (n = 72) were diagnosed with paroxysmal AF. The mean
age was 62.8±0.7 years. The baseline
CHA2DS2-VASc score was 1.7±0.1.
The median duration between the two admissions was 11 months (IQR: 6-22
months). The △ CHA2DS2-VASc score
was 0.2±0.0. The mean eGFR at readmission was significantly increased
compared with the eGFR at baseline before the index RFCA procedure
(81.5±1.1 vs. 78.0±0.7 ml/min/1.73 m², P <
0.01), as shown in Figure 1. After all patients underwent successful
CPVI, 94 (71.2%) patients showed paroxysmal atrial arrhythmia and the
remaining 38 (28.8%) showed persistent atrial arrhythmia when
readmitted due to recurrence.
Among the 4 groups classified based on patterns of arrhythmia change,
the difference in △ eGFR was statistically significant (P =
0.03), as shown in Figure 2. Figure 3 shows that patients with
recurrence of paroxysmal atrial arrhythmia had better renal function
outcomes regardless of whether they initially had paroxysmal or
persistent AF (P < 0.001 and P = 0.004,
respectively).
In the univariate Cox regression, the△ CHA2DS2-VASc score, left atrial
diameter (LAD) and recurrent atrial arrhythmia type were significantly
associated with changes in eGFR. Although not a significant factor in
the univariate Cox regression, baseline age was still included in the
multivariate analysis because age has always been a strong risk factor
for renal dysfunction. As shown in Table 2, after adjusting for baseline
age and the △ CHA2DS2-VASc score,
LAD and recurrent atrial arrhythmia type, the multivariate Cox
regression showed that a lower△ CHA2DS2-VASc score (hazard ratio
[HR]: 0.416, 95% confidence interval [CI]: 0.235-0.735,P = 0.003) and paroxysmal recurrent atrial arrhythmia (HR: 2.965,
95% CI: 1.604-5.483, P = 0.001) were associated with better
renal function.