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. 2024 Nov;10(11):2431-2444.
doi: 10.1016/j.jacep.2024.07.007. Epub 2024 Sep 4.

Renal Outcomes of Rhythm Control in Patients Recently Diagnosed With Atrial Fibrillation

Daehoon Kim  1 , Pil-Sung Yang  2 , Eunsun Jang  1 , Hee Tae Yu  1 , Tae-Hoon Kim  1 , Jae-Sun Uhm  1 , Hui-Nam Pak  1 , Moon-Hyoung Lee  1 , Gregory Y H Lip  3 , Jung-Hoon Sung  4 , Boyoung Joung  5
Affiliations

Renal Outcomes of Rhythm Control in Patients Recently Diagnosed With Atrial Fibrillation

Daehoon Kim et al. JACC Clin Electrophysiol. 2024 Nov.

Abstract

Background: Atrial fibrillation (AF) is associated with impaired renal function and chronic kidney disease (CKD).

Objectives: This study assessed the effects of rhythm control on renal function compared with rate control among patients recently diagnosed with AF.

Methods: A total of 20,886 patients with AF and available baseline estimated glomerular filtration rate (eGFR) data undergoing rhythm control (antiarrhythmic drugs or ablation) or rate control therapy, initiated within 1 year of AF diagnosis in 2005 to 2015, were identified from the Korean National Health Insurance Service database. The composite outcome of ≥30% decline in eGFR, acute kidney injury, kidney failure, or death from renal or cardiovascular causes was compared with the use of propensity overlap weighting between rhythm or rate control strategies in patients with or without significant CKD (eGFR <60 mL/min/1.73 m2).

Results: Of the included patients (median age 62 years, 32.7% female), 2,213 (10.6%) had eGFR <60 mL/min/1.73 m2. Among patients with significant CKD, early rhythm control, compared with rate control, was associated with a lower risk of the primary composite outcome (weighted incidence rate: 2.77 vs 3.92 per 100 person-years; weighted HR: 0.70; 95% CI: 0.52-0.95). In patients without significant CKD, there was no difference in the risk of the primary composite outcome between rhythm and rate control groups (weighted incidence rate: 3.41 vs 3.21 per 100 person-years; weighted HR: 1.06; 95% CI: 0.96-1.18). No differences in safety outcomes were found between rhythm and rate control strategies in patients without or with significant CKD.

Conclusions: Among patients with AF and CKD, early rhythm control was associated with lower risks of adverse renal outcomes than rate control was.

Keywords: atrial fibrillation; chronic kidney disease; rate control; renal outcome; rhythm control.

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Conflict of interest statement

Funding Support and Author Disclosures This research was supported by a grant from the Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health and Welfare, Republic of Korea (HC19C0130), a grant from the Korean Cardiac Research Foundation (202303-01), and a grant from the Korean Heart Rhythm Society (KHRS2023-2). Dr Lip has been consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Anthem, with no fees received personally; and is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement no. 899871. Dr Joung has served as a speaker for Bayer, BMS/Pfizer, Medtronic, and Daiichi-Sankyo; and has received research funds from Medtronic and Abbott, with no fees received directly or personally. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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