title: Renal dysfunction and atrial fibrillation recurrence following cardioversion.
abstract: BACKGROUND
  No previous study has assessed the role of renal impairment in predicting the long-term risk of atrial fibrillation recurrence after cardioversion.
  
  
  METHODS
  One hundred and fifty-nine consecutive patients with persistent atrial fibrillation undergoing successful cardioversion were enrolled. Renal function was assessed based on the estimated glomerular filtration rate (eGFR) at baseline and during follow-up. Patients were prospectively followed up for eGFR and recurrence of atrial fibrillation up to 1 year.
  
  
  RESULTS
  Patients were divided into 4 groups based upon their eGFR (group 1 >90 mL/min: 33 patients, group 2: 60-90 mL/min: 55 patients, group 3: 30-59 mL/min: 53 patients, group 4: <30 mL/min: 18 patients). Overall, 101 out of 159 (64%) patients experienced atrial fibrillation recurrence within 1 year follow-up. Atrial fibrillation recurrence was independently associated with the level of reduction of eGFR at baseline (eGFR < 30 mL/min: hazard ratio [HR] 6.82, P < 0.001; eGFR 30-59 mL/min: HR 3.31, P = 0.01; eGFR 60-90 mL/min: HR 2.10, P = 0.13; eGFR > 90 mL/min reference group). In patients with maintained sinus rhythm after 12-month follow-up eGFR was increased (8.46 ± 9.49 mL/min [range -7 to 43]), whereas patients with atrial fibrillation recurrence showed a decrease in eGFR over time (-5.75 ± 9.4 [range -32 to 25], P < 0.001).
  
  
  CONCLUSIONS
  Among a group of patients with persistent atrial fibrillation undergoing successful cardioversion, impaired renal function (based on estimated GFR) was associated with an increased risk of atrial fibrillation recurrence. Maintenance of sinus rhythm was associated with improvement in eGFR in patients with mild or moderate renal insufficiency.
authors.affiliation: Department of Cardiology, Klinikum Coburg, Germany. mschmidtco@arcor.de
authors.forename: Martin
authors.initials: M
authors.lastname: Schmidt
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Harald
authors.initials: H
authors.lastname: Rittger
authors.forename: Harald
authors.initials: H
authors.lastname: Marschang
authors.forename: Stefan
authors.initials: S
authors.lastname: Holzmann
authors.forename: Philip
authors.initials: P
authors.lastname: Jung
authors.forename: Davor
authors.initials: D
authors.lastname: Bojanic
authors.forename: Markus
authors.initials: M
authors.lastname: Ketteler
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Johannes
authors.initials: J
authors.lastname: Rieber
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects*; D005260:Female; D005858:Germany; D005919:Glomerular Filtration Rate; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome