Glomerular Filtration Rate by Differing Measures in Predicting Atrial Fibrillation Recurrence After Ablation

Significant differences often exist between estimated glomerular filtration rates (eGFR) calculated using various biomarkers. However, the relationship between these eGFR methods and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) remains unclear.

Thus, this study employed a retrospective analysis of 523 patients with AF who underwent an initial RFCA between July 2019 and October 2022. The eGFR was calculated using three methods based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula: serum creatinine (eGFRcr), serum cystatin C (eGFRcys), and a combination of both (eGFRcrcys). Cox regression models were used to explore the relationship between eGFR and AF recurrence.

Over a 1-year follow-up period, 174 (33.3%) patients experienced AF recurrence after RFCA. Multivariable Cox regression analysis indicated that only eGFRcys showed a consistent, significant inverse association with AF recurrence (hazard ratio (HR) = 0.990, 95% confidence interval (CI): 0.982-0.998, p = 0.019). In contrast, eGFRcrcys showed borderline significance after full adjustment (p = 0.067). Meanwhile, stratifying by optimal cutoff values identified an association for eGFRcys ≤64.280 mL/min/1.73 m², and eGFRcrcys ≤76.093 mL/min/1.73 m² with significantly higher recurrence risks after full adjustment (p = 0.008 and p = 0.036, respectively). Additionally, incorporating eGFRcys or eGFRcrcys into the baseline risk model led to a greater improvement in predictive accuracy than adding eGFRcr.

The association between eGFR and AF recurrence after ablation appears to vary depending on the measurement methods; eGFRcys seems to provide the most reliable information. Incorporating eGFRcys into the pre-ablation risk stratification may enhance patient management and improve outcomes for patients undergoing AF ablation.