Impact of renal dysfunction on left atrial low-voltage areas in patients with atrial fibrillation

Abstract

Background: The presence of residual left atrial low-voltage areas (LVA) has been shown to be strongly associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation. A preliminary study showed that concomitant chronic kidney disease (CKD) increased the rate of AF recurrence. The association between CKD and LVA, however, has not been elucidated. In the present study, we investigated the association between CKD severity and LVA prevalence. Methods and Results: In total, 183 consecutive AF patients who underwent initial ablation for AF were enrolled in this retrospective observational study. Serum cystatin C before ablation was measured, and the estimated glomerular filtration rate (eGFR) was calculated. LVA were defined as sites of left atrial electrogram amplitude <0.5 mV. Of 183 patients, 76 (42%) had LVA. Patients with LVA had lower eGFR calculated using cystatin C (74±22 vs. 86±24 mL/min/1.73 m2, P=0.001). The optimal cut-off of the calculated eGFR was 71.5 mL/min/1.73 m2, corresponding to a 79.4% sensitivity, 50% specificity, and 67.2% predictive accuracy. LVA occurred more frequently in patients with more severe categories of CKD. On multivariate analysis, eGFR <71.5 mL/min/1.73 m2 was an independent predictor of LVA (odds ratio, 3.3; 95% CI: 1.4-7.8; P=0.006). Conclusions: CKD severity was correlated with left atrial LVA prevalence in patients with AF undergoing catheter ablation.