Background:Renal dysfunction coexists with other known risk factors of left atrial (LA) structural remodeling, expressed as low-voltage zones (LVZs), and the recurrence of atrial fibrillation (AF) after ablation. This study aimed to determine whether renal dysfunction had an independent effect on the presence of LVZs and recurrence after AF ablation, using propensity score (PS) matching analysis.

Methods and Results:448 consecutive patients who underwent their initial AF ablation were enrolled. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², with 126 (28%) patients having CKD. Using PS matching analysis, new subsets (CKD and non-CKD group, n=103 each) were obtained, matched for age, sex, AF type, and LA volume. The presence of LVZs defined as bipolar voltage <0.5 mV was higher in the CKD group than in the non-CKD group (31% vs. 17%, P=0.034). Multivariate analysis showed eGFR was an independent predictor of the presence of LVZs (odds ratio 1.31 per 10-mL/min/1.73 m²decrease, P=0.029). AF-free survival rate was significantly lower in the CKD patients during 20±9 months of follow-up (63% vs. 82%, P=0.019), and eGFR was shown to be an independent predictor of recurrence (hazard ratio 1.29 per 10-mL/min/1.73 m²decrease, P=0.006), but the presence of LVZs did not predict recurrence.

Conclusions:Renal dysfunction independently predicted not only the recurrence of AF after ablation but also the presence of LVZs.

背景：肾功能不全与其他已知的左心房（LA）结构重塑的危险因素共存，表现为低压区（LVZs）和消融后房颤（AF）复发。这项研究旨在通过倾向评分（PS）匹配分析来确定肾功能不全是否对LVZ的存在和AF消融后的复发具有独立的影响。

方法和结果：入选了448例连续进行了首次房颤消融的患者。慢性肾病（CKD）定义为肾小球滤过率（eGFR）<60 mL / min / 1.73 m ²，其中126名患者（28％）患有CKD。使用PS匹配分析，获得了新的子集（CKD和非CKD组，每个n = 103），它们匹配了年龄，性别，AF类型和LA体积。定义为双极性电压<0.5 mV的LVZ在CKD组中高于非CKD组（31％vs. 17％，P = 0.034）。多变量分析表明eGFR是LVZs存在的独立预测因子（每10 mL / min / 1.73 m ^2的几率1.31减少，P = 0.029）。随访20±9个月，CKD患者的无AF生存率显着降低（63％比82％，P = 0.019），并且eGFR被证明是复发的独立预测因子（危险比1.29 /降低10mL / min / 1.73 m ²，P = 0.006），但是LVZ的存在不能预测复发。

结论：肾功能不全不仅可以预测消融后房颤的复发，而且可以预测LVZ的存在。