title: Renal function after repeat catheter ablation for long-standing persistent atrial fibrillation : Low CHA2DS2-VASc score and sinus rhythm predict improved renal function.
abstract: BACKGROUND
  Renal impairment and atrial fibrillation (AF) often coexist. Catheter ablation is an effective way to reduce the burden of AF and improve symptoms; however, little is known about the relationship between renal function and AF and its role in the progression of AF for patients undergoing repeat catheter ablation.
  
  
  METHODS
  In all, 171 patients with long-standing persistent AF ablation were enrolled in the study. The patients were divided into two groups according to their delta estimated glomerular filtration rate (eGFR) values, which was defined as the eGFR before the repeat procedure minus the eGFR before the initial procedure. Patients with decreasing eGFR (delta eGFR < 0) were categorized as group I, while individuals with no change or increasing eGFR (delta eGFR≥ 0) were categorized as group II. eGFR was estimated at baseline and at the 12-month and 24-month follow-up visits.
  
  
  RESULTS
  After a mean follow-up of 31.4 ± 13.2 months, group I had a significantly higher arrhythmia recurrence rate than group II (71.2 vs. 49.2 %, p < 0.001). On multivariable analyses, eGFR changes after the repeat procedure were associated with arrhythmia recurrence, hypertrophic cardiomyopathy, and CHA2DS2-VASc score. Patients with arrhythmia recurrence and those with a CHA2DS2-VASc score of ≥ 3 were more likely to show an eGFR decline at follow-up.
  
  
  CONCLUSIONS
  Patients with long-standing persistent AF, with a failed initial ablation procedure and undergoing a repeat ablation procedure, appear to have a higher risk of arrhythmia recurrence. During the follow-up period, patients without arrhythmia recurrence and those with a CHA2DS2-VASc score of < 3 show improved renal function.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, 200030, Shanghai, People's Republic of China.|Department of Cardiology, Cardiovascular Research Laboratory, and Central Laboratory, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, 200030, Shanghai, People's Republic of China.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, 200030, Shanghai, People's Republic of China.
authors.forename: X-D
authors.initials: XD
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, 200030, Shanghai, People's Republic of China. xkliuxu@126.com.
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, 200030, Shanghai, People's Republic of China. yang99yang66@hotmail.com.|Department of Cardiology, Cardiovascular Research Laboratory, and Central Laboratory, Shanghai Chest Hospital, Shanghai Jiaotong University, No. 241 West Huaihai Road, 200030, Shanghai, People's Republic of China. yang99yang66@hotmail.com.
authors.forename: Y-Q
authors.initials: YQ
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015984:Causality; D002908:Chronic Disease; D015897:Comorbidity; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D007677:Kidney Function Tests / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Atrial fibrillation; CHA2DS2-VASc score; Estimated glomerular filtration rate; Renal function; Repeat catheter ablation
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