Acute Kidney Injury Post Cardioversion for Atrial Fibrillation: a Prospective Study

Introduction: The incidence of acute kidney injury (AKI) after direct current cardioversion (DCCV) in patients with atrial fibrillation/flutter is poorly investigated, mostly described by retrospective studies. In this prospective study our aim was to evaluate the incidence and risk for AKI post cardioversion and its correlation to mortality.

Methods: this is a single center prospective observational study in which we studied a cohort of 51 patients who underwent 56 DCCV (5 re-do). We evaluated kidney functions before, right after and 7-days after the procedure. According to the recent the guidelines, AKI is defined as an increase of serum creatinine (sCr) of ≥ 0.3 mg/dl or ≥ 1.5×baseline creatinine

Results: Patients’ mean age was 67.5 years, 57.1% were males. 80.3% of the patients had hypertension, 58.9% dyslipidemia, 26.8% ischemic heart disease. 25% were post CVA/TIA, and 21.4% had diabetes.The mean CHADSVASC score was 3.32, and the NYHA functional class 2.16 and performed an average of 359m on 6MWT prior to the DCCV.

DCCV were performed once, twice, or three times( 1.23 shocks per patient). Restoration of sinus rhythm was achieved in 89.3% of the attempts. Only 6 patients (10.7) remained with atrial fibrillation/flutter. Three patients (5.36%) developed transient AKI, however none of them required hemodialysis. Risk factors for AKI were baseline creatinine(p=0.05), magnesium blood level (p=0.03), patients who developed CHF exacerbation after DCCV (p=0.027) and patients who did not received peri-procedural fluids(p=0.004).

Conclusions: AKI after DCCV is rare complication with several possible mechanisms and risk factors. In our study risk factors for AKI after DCCV are baseline creatinine, magnesium and patients who did not receive fluids peri-procedurally and patients at risk were also those who developed CHF exacerbation after the procedure.