Catheter Ablation -> Ventricular Arrhythmias -> Electrocardiography D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-080 - Periprocedural Acute Kidney Injury In Patients With Structural Heart Disease Undergoing Catheter Ablation Of Ventricular Tachycardia: Incidence, Predictors And Impact On Outcomes (ID 1354)

Abstract

Background: Catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease (SHD) has risk of significant periprocedural hemodynamic derangements, which may affect end-organ perfusion and precipitate acute kidney injury (AKI). The clinical significance of periprocedural AKI in patients with SHD undergoing VT ablation is unknown.
Objective: To examine the impact of periprocedural AKI in patients with SHD undergoing VT ablation.
Methods: We included a total of 317 consecutive patients with SHD (age 64±13 years, mean LVEF 33%±13%, 55% ischemic cardiomyopathy) undergoing catheter ablation of VT at our institution between 2010 and 2013, who had serial assessments of serum creatinine levels pre- and post-procedure. Periprocedural AKI was defined as an absolute increase in creatinine of ≥0.3 mg/dL within 48 hours or an increase of >1.5 times the baseline values within 1 week post-procedure.
Results: Periprocedural AKI occurred in 31 (10%) patients. Predictors of AKI included atrial fibrillation (OR 3.74, 95% CI 1.66 to 8.42, P=0.001), chronic kidney disease (OR 3.62, 95% CI 1.64 to 7.98, P=0.001), periprocedural acute hemodynamic decompensation (OR 5.04, 95% CI 1.76-14.40, P=0.003), and use of angiotensin converting enzyme inhibitor/angiotensin II receptor blockers (OR 3.11, 95% CI 1.16 to 8.38, P=0.024). After a median follow-up of 39 months (IQR 6 to 65 months), 95 (30%) patients died. Periprocedural AKI was associated with increased risk of early mortality (within 30 days, hazard ratio [HR] 9.91, 95% CI 2.87-34.22, P<0.001) and late mortality (within 1 year) following the procedure (HR 4.57, 95% CI 2.08-10.05, P<0.001). After multivariable adjustment, AKI remained independently associated with increased risk of early and late mortality (HR 7.23, 95% CI 1.89-27.7, P=0.04 and HR 3.12, 95% CI 1.34-7.23, P=0.008, respectively).
Conclusion: Periprocedural AKI occurs in at least 10% of patients with SHD undergoing VT ablation, and is strongly associated with increased risk of early and late post-procedural mortality. Serial assessments of kidney function following the procedure should be considered in this population, and defining strategies to minimize the risk of periprocedural AKI is crucial.
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