Background-—Although it has been reported that renal function can improve after catheter ablation of atrial fibrillation (AF), longterm changes in renal function and its relationship to rhythm outcomes have not yet been evaluated. We explored the 5-year change in estimated glomerular filtration rate (eGFR) in AF patients depending on medical therapy and catheter ablation. Methods and Results-—Among 1963 patients who underwent AF catheter ablation and 14 056 with AF under medical therapy in the National Health Insurance Service database, we compared 571 with AF catheter ablation (5910 years old, 72.3% male, and 66.5% paroxysmal AF) and 1713 with medical therapy after 1:3 propensity-score matching. All participants had 5 years of serial eGFR data (Chronic Kidney Disease-Epidemiology Collaboration [CKD-EPI] method). Catheter ablation improved eGFR5 yrs (P<0.001), but medical therapy did not. In 2284 matched patients, age (adjusted odds ratio [OR], 0.98 [0.97–0.99]; P<0.001) and AF catheter ablation (adjusted OR, 2.02 [1.67–2.46]; P<0.001) were independently associated with an improved eGFR5 yrs. Among 571 patients who underwent AF ablation, freedom from AF/atrial tachycardia recurrence after the last AF ablation procedure was independently associated with an improved eGFR5 yrs (adjusted OR, 1.44 [1.01–2.04]; P=0.043), especially in patients without diabetes mellitus (adjusted OR, 1.78 [1.21–2.63]; P=0.003, P for interaction=0.012). Although underlying renal dysfunction (<60 mL/min/1.73m2) was associated with atrial structural remodeling (adjusted OR, 1.05 [1.00–1.11]; P=0.046), it did not affect the AF ablation rhythm outcome. Conclusions-—AF catheter ablation significantly improved renal function over a 5-year follow-up, especially in patients maintaining sinus rhythm without preexisting diabetes mellitus.
Bibliographical noteFunding Information:
This work was supported by a grant (HI18C0070) from the Korea Health 21 R&D Project, Ministry of Health and Welfare and a grant (NRF-2017R1A2B4003983) from the Basic Science Research Program run by the National Research Foundation of Korea (NRF), which is funded by the Ministry of Science, ICT, and Future Planning (MSIP). This study used the NHIS-NSC data (NHIS-2018-2-189) made by the National Health Insurance Service (NHIS).
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine