title: Impact of impaired renal function and metabolic syndrome on the recurrence of atrial fibrillation after catheter ablation: a long term follow-up.
abstract: BACKGROUND
  The goal of this study was to analyze impact of metabolic syndrome (MetS) and impaired renal function on long-term follow-up after catheter ablation of atrial fibrillation (AF).
  
  
  RESULTS
  A total of 702 consecutive patients with AF (age = 58 year, history of AF = 5 year, male = 478, paroxysmal atrial fibrillation = 416, coronary artery disease = 62, hypertension = 487) considered for catheter ablation were enrolled in the study. The MetS was diagnosed at admission in 276 patients. The renal function was estimated by glomerular filtration rate (eGFR). Pulmonary vein isolation (PVI) was performed either with cryoballoon technique (n = 260) or circumferential PVI (n = 442) with a 3.5-mm irrigated tip catheter. A 7-day-Holter electrocardiogram was performed at each follow-up visit. Any episode of documented AF after an initial 3-month blanking period was considered as clinical endpoint. Out of 702 patients, 370 (52.7%) were free of AF recurrences at median follow-up of 15 six interquartile range (12.7-42.3) months. The patients with MetS had significantly lower success rate than those without (128/276 (46.4%) vs 242/426 (56.8%), P = 0.006). Among 103 patients with eGFR < 68 mL/min only 35 (34%) were free of recurrences compared with 335/599 (55.9%) in patients with GFR ≥ 68 mL/min (P = 0.001). Both parameters were revealed in multivariate analysis to be independent predictors for outcome after catheter ablation.
  
  
  CONCLUSIONS
  The results of our study clearly demonstrated that outcome after 1st catheter ablation of AF is poor in patients with MetS and/or impaired renal function. This observation has a potential clinical impact for the follow up management of these patients.
authors.affiliation: Kerckhoff Heart Centre, Bad Nauheim, Germany. a.berkowitsch@kerckhoff-klinik.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Berkowitsch
authors.forename: Malte
authors.initials: M
authors.lastname: Kuniss
authors.forename: Harald
authors.initials: H
authors.lastname: Greiss
authors.forename: Maciej
authors.initials: M
authors.lastname: Wójcik
authors.forename: Sergey
authors.initials: S
authors.lastname: Zaltsberg
authors.forename: Stefan
authors.initials: S
authors.lastname: Lehinant
authors.forename: Damir
authors.initials: D
authors.lastname: Erkapic
authors.forename: Dimitri
authors.initials: D
authors.lastname: Pajitnev
authors.forename: Heinz-Friedrich
authors.initials: HF
authors.lastname: Pitschner
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000601:surgery; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome