The impact of chronic kidney disease on the morphofunctional and electrical remodeling of the heart in patients with persistent atrial fibrillation undergoing coronary artery bypass graft surgery with concomitant radiofrequency ablation


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Abstract

Aim of the study. To assess the effects of chronic kidney disease (CKD) on the morphological, functional and electrical remodeling of the heart in patients with persistent AF undergoing CABG and concomitant radiofrequency ablation (RFA) of pulmonary vein ostia.
Materials and methods. 318 patients (208 men and 110 women) aged 48 to 65 years (mean age 59.4±6.3 years) underwent clinical investigation before and 12 months after CABG combined with RFA. Patients were divided into two groups depending on the initial glomerular filtration rate (GFR): 234 patients had GFR above 60 ml/min/1.73 m2 (group 1) and 75 patients had GFR below 60 ml/min/1.73 m2 (group 2).
Results. At 12 months after surgery GFR in group 2 increased by an average of 24.9% (p=0.007), which was
13.8% (p=0.012) lower than in group 1. Despite significant improvements in the characteristics of cardiac hemodynamics in group 2, their mean values were significantly inferior to those in group 1. In addition, in patients with stable sinus rhythm measures of left atrial effective refractory period (LAERP) and arrhythmia induction pacing frequency threshold (AIPFT) significantly increased, while heart rate and frequency of f-waves during in AF, on the contrary, decreased. At 12 months after surgery 76.5% of patients of group 1 and 62.7% of patients of group 2 retained a stable sinus rhythm without antiarrhythmic drugs(p=0.036).It was found that successful RFA resulted in significantly higher GFR (p<0.001), then in patients with recurrent AF.
Conclusion. It was demonstrated that the reduced GFR affects the morphofunctional and electrical remodeling of the heart and is a risk factor for late recurrence of AF after CABG with concomitant RFA.

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