title: Renal dysfunction and the risk of thromboembolic events in patients with atrial fibrillation after catheter ablation--the potential role beyond the CHA₂DS₂-VASc score.
abstract: BACKGROUND
  Renal dysfunction is recognized as an important risk factor for thromboembolic (TE) events in patients with atrial fibrillation (AF) under medical treatment.
  
  
  OBJECTIVE
  To investigate whether renal dysfunction is a useful predictor of TE events among patients receiving AF ablation. We also aimed to determine whether the diagnostic accuracy of the CHA(2)DS(2)-VASc score in predicting TE events could be improved by adding renal dysfunction into the scoring system.
  
  
  METHODS
  We enrolled a total of 547 patients with AF who underwent catheter ablation. Renal dysfunction was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m(2). The clinical end point was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during follow-up after catheter ablation.
  
  
  RESULTS
  During a follow-up of 38.9 ± 22.5 months, 16 patients (2.9%) experienced TE events. Both the CHA(2)DS(2)-VASc score and renal dysfunction were independent predictors of TE events in the multivariate analysis. Among patients with a CHA(2)DS(2)-VASc score of 0 or 1, renal dysfunction can further stratify them into 2 groups with different event rates (4.3% vs 0.3%; P = .046). A new scoring system derived by assigning 1 more point representing renal dysfunction to the CHA(2)DS(2)-VASc score could improve its predictive accuracy; the area under the receiver operating characteristic curve increased from 0.84 to 0.88 (P = .043).
  
  
  CONCLUSIONS
  Renal dysfunction was a significant risk factor for TE events after catheter ablation of AF and may improve the diagnostic accuracy of the CHA(2)DS(2)-VASc score.
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tze-Fan
authors: TF
authors: Chao
authors: Hsuan-Ming
authors: HM
authors: Tsao
authors: Kibos
authors: K
authors: Ambrose
authors: Yenn-Jiang
authors: YJ
authors: Lin
authors: Wei-Shiang
authors: WS
authors: Lin
authors: Shih-Lin
authors: SL
authors: Chang
authors: Li-Wei
authors: LW
authors: Lo
authors: Yu-Feng
authors: YF
authors: Hu
authors: Ta-Chuan
authors: TC
authors: Tuan
authors: Kazuyoshi
authors: K
authors: Suenari
authors: Cheng-Hung
authors: CH
authors: Li
authors: Beny
authors: B
authors: Hartono
authors: Hung-Yu
authors: HY
authors: Chang
authors: Fa-Po
authors: FP
authors: Chung
authors: Dicky A
authors: DA
authors: Hanafy
authors: Wen-Yu
authors: WY
authors: Lin
authors: Shih-Ann
authors: SA
authors: Chen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D051437:Renal Insufficiency / Q000209:etiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology*