Impact of cardiorenal syndrome on clinical outcomes of atrial fibrillation patients undergoing catheter ablation

Abstract

Abstract Background Heart failure (HF) coexists with both atrial fibrillation (AF) and chronic kidney disease (CKD) and exacerbate each other. All of them are increasing in the aging society all over the world. Little is known regarding the impact of cardiorenal syndrome (CRS) on clinical outcomes of patients with AF undergoing catheter ablation (AFCA) in the real-world setting. Purpose In the present study, we investigated clinical outcomes of CRS patients with de novo AFCA. Method: Consecutive 494 patients (68.1±11.1 yrs, male 68.0%) undergoing de novo AF catheter ablation in our hospital from April 2019 to March 2021 were enrolled. CRS was defined as having both HF and CKD. HF was defined as having a history of HF admission and/or BNP≥100 pg/mL. CKD was defined as eGFR< 60 ml/min/1.73m2. The primary outcome was composite outcomes of; all-cause death, redo ablation, thromboembolisms, atherosclerotic cardiovascular disease (ASCVD) events, major bleeding, HF admission, and dialysis initiation. Result The incidence of primary outcome in CRS patients during median follow-up periods of 739.5 days was significantly higher than the non-CRS patients (54.9% in CRS vs. 30.3% in non-CRS; P<0.01, Figure 1). In CRS patients, all-cause death, ASCVD events, and HF admission were significantly worse (7.7% in CRS vs. 0.3% in non-CRS; P<0.01, 10.3% in CRS vs. 1.8% in non-CRS; P<0.01, 11.5% in CRS vs. 0.9% in non-CRS; P<0.01, respectively, Table), however redo ablation, thromboembolism, major bleeding and dialysis initiation were similar compared with non-CRS patients (10.3% in CRS vs. 14.5% in non-CRS; P=0.25, 1.3% in CRS vs. 0.6% in non-CRS; P=0.59, 5.1% in CRS vs. 2.1% in non-CRS; P=0.09, 1.3% in CRS vs. 0.3% in non-CRS; P=0.24, respectively, Table). The incidence of primary outcome in CRS patients was similar in those with ejection fraction (EF)≤40% and in those with EF>40% (47.6% in EF≤40% vs. 54.7% in EF>40%; P=0.48, Figure 2), however it was significantly higher in those with eGFR<45 compared with those with eGFR≥45 (74.8% in eGFR<45 vs. 26.2% in eGFR≥45+ P<0.01, Figure 3). Conclusion CRS patients with AFCA had significantly worse outcomes with more all-cause death, ASCVD events and HF admission compared with non-CRS patients. In the CRS patients undergoing AFCA, worse kidney function, rather than the cardiac systolic function, had a significant prognostic impact on the over-all clinical outcomes.