AF导管消融术后肾功能亦得以改善

丹佛——犹他大学的电生理学家Nazem W. Akoum博士在心律学会(HRS)2013年会上报告报告称，对于心房颤动(AF)合并中度慢性肾病的患者而言，AF导管消融术可能产生额外益处——改善肾功能。

Nazem Akoum博士

该研究中排除了AF合并5期或6期CKD的患者，原因是消融前需要通过使用钆造影剂的延时增强MRI对心房纤维化程度进行量化评估，而晚期CKD患者暴露于钆不安全。1期或2期CKD患者平均左心房纤维化程度为15.8%，3期或4期CKD患者平均为19.1%。

结果显示，在成功接受AF导管消融术的81例3期或4期慢性肾病(CKD)患者中，平均估计肾小球滤过率(eGFR)显著改善，自基线时的46.7 ml/min·1.73 m²增至术后随访3个月时的53 ml/min·1.73 m²。而接受AF导管消融治疗的382例1期或2期CKD患者的eGFR无显著改变，这些患者基线时的平均eGFR为103.6 ml/min·1.73 m²。在3期或4期CKD组中发现的恢复窦性节律后的eGFR改善似乎与左心室收缩功能或药物效应无关。消融后心室活动的正常化以及随之而来的内皮功能改善可能对这一肾脏益处有所贡献。

研究者总结认为，对于AF合并中度CKD患者，AF导管消融术同时可改善肾功能。

Akoum医生披露无相关利益冲突。

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By: BRUCE JANCIN, Cardiology News Digital Network
 
DENVER – Catheter ablation of atrial fibrillation in patients with comorbid moderate chronic kidney disease may have a side benefit: improved renal function, according to Dr. Nazem W. Akoum.

Among 81 patients with stage 3 or 4 chronic kidney disease (CKD) who underwent successful AF ablation, the mean estimated glomerular filtration rate (eGFR) improved significantly, from 46.7 mL/min per 1.73 m2 at baseline to 53 mL/min per 1.73 m2 at follow-up 3 months post procedure, Dr. Akoum reported at the annual meeting of the Heart Rhythm Society.
 
In contrast, the eGFR in 382 patients with stage 1 or 2 CKD who underwent AF ablation didn’t change significantly, from a baseline mean of 103.6 mL/min per 1.73 m2, added Dr. Akoum, an electrophysiologist at the University of Utah, Salt Lake City.

Patients with AF and stage 5 or 6 CKD were excluded from participation in this study. Given the requirement for preablation quantification of the extent of atrial fibrosis via delayed-enhancement MRI with gadolinium contrast, there were safety concerns regarding exposing patients with advanced CKD to gadolinium.

Patients with stage 1 or 2 CKD averaged 15.8% left atrial fibrosis, while stage 3 or 4 patients averaged 19.1%.

The improvement in eGFR noted in the group with stage 3 or 4 CKD following restoration of sinus rhythm appeared to be independent of left ventricular systolic performance or medication effects. The postablation regularization of ventricular activation and the resultant improvement in endothelial function may have contributed to the welcome renal side benefit, Dr. Akoum said.

He reported having no relevant financial conflicts.