Renal dysfunction and the risk of thromboembolic events in patients with atrial fibrillation after catheter ablation--the potential role beyond the CHA₂DS₂-VASc score

Heart Rhythm. 2012 Nov;9(11):1755-60. doi: 10.1016/j.hrthm.2012.06.039. Epub 2012 Jun 30.


Background: Renal dysfunction is recognized as an important risk factor for thromboembolic (TE) events in patients with atrial fibrillation (AF) under medical treatment.

Objective: To investigate whether renal dysfunction is a useful predictor of TE events among patients receiving AF ablation. We also aimed to determine whether the diagnostic accuracy of the CHA(2)DS(2)-VASc score in predicting TE events could be improved by adding renal dysfunction into the scoring system.

Methods: We enrolled a total of 547 patients with AF who underwent catheter ablation. Renal dysfunction was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m(2). The clinical end point was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during follow-up after catheter ablation.

Results: During a follow-up of 38.9 ± 22.5 months, 16 patients (2.9%) experienced TE events. Both the CHA(2)DS(2)-VASc score and renal dysfunction were independent predictors of TE events in the multivariate analysis. Among patients with a CHA(2)DS(2)-VASc score of 0 or 1, renal dysfunction can further stratify them into 2 groups with different event rates (4.3% vs 0.3%; P = .046). A new scoring system derived by assigning 1 more point representing renal dysfunction to the CHA(2)DS(2)-VASc score could improve its predictive accuracy; the area under the receiver operating characteristic curve increased from 0.84 to 0.88 (P = .043).

Conclusions: Renal dysfunction was a significant risk factor for TE events after catheter ablation of AF and may improve the diagnostic accuracy of the CHA(2)DS(2)-VASc score.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects*
  • Chi-Square Distribution
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Proportional Hazards Models
  • ROC Curve
  • Renal Insufficiency / etiology*
  • Risk Factors
  • Sensitivity and Specificity
  • Survival Rate
  • Thromboembolism / etiology*