Serge A Trines1, Giuseppe Stabile2, Elena Arbelo3,4,5, Nikolaos Dagres6, Josep Brugada3,4,5, Josef Kautzner7, Evgeny Pokushalov8, Aldo P Maggioni9,10, Cécile Laroche10, Matteo Anselmino11, Roy Beinart12, Vassil Traykov13, Carina Blomström-Lundqvist14. 1. Heart Lung Centre, Leiden University Medical Centre, Leiden, Netherlands. 2. Clinica Montevergine, Mercogliano (AV), and Clinica San Michele, Maddaloni, (CE), Italy. 3. Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 4. Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 5. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. 6. Department of Electrophysiology, Heart Center Leipzig at the University of Leipzig, Leipzig, Germany. 7. Institute for Clinical and Experimental Medicine (IKEM), Praha, Czech Republic. 8. E. Meshalkin National medical research center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia. 9. ANMCO Research Centre, Florence, Italy. 10. EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis Cedex, France. 11. Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Italy. 12. Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center Ramat Gan, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. 13. Acibadem City Clinic Tokuda Hospital Sofia. 14. Department of Cardiology, Department of Medical Science, Uppsala University, Uppsala, Sweden.
Abstract
BACKGROUND: The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub-analysis of the European Society of Cardiology-European Heart Rhythm Association-European Society of Cardiology AF ablation long-term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real-world data. METHODS: Risk factors for AF were defined as body mass index ≥27 kg/m², hypertension, chronic obstructive pulmonary disease, diabetes, alcohol ≥2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with ≥1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression. RESULTS: Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49-0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence. CONCLUSIONS: Patients with ≥1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death.
BACKGROUND: The influence of risk factors on atrial fibrillation (AF) ablation recurrence is increasingly recognized. We present a sub-analysis of the European Society of Cardiology-European Heart Rhythm Association-European Society of Cardiology AF ablation long-term registry on the effect of traditional risk factors for AF on postablation recurrence, reablation, and complications using real-world data. METHODS: Risk factors for AF were defined as body mass index ≥27 kg/m², hypertension, chronic obstructive pulmonary disease, diabetes, alcohol ≥2 units/day, sleep apnea, smoking, no/occasional sports activity, moderate/severe mitral or aortic valve disease, any cardiomyopathy, peripheral vascular disease, chronic kidney disease, heart failure, coronary artery disease/infarction, and previous pacemaker/defibrillator implant. Patients were divided in two groups with ≥1 or without risk factors. Primary outcomes were arrhythmia recurrence after blanking period, reablation, and adverse events or death. Differences between the groups and the influence of individual risk factors were analyzed using multivariate Cox regression. RESULTS: Three thousand sixty nine patients were included; 217 patients were without risk factors. Risk factor patients were older (58.4 vs 54.1 years), more often female (32% vs 19.8%) and had more often persistent AF (27.2% vs 23.5%). In a multivariate analysis, patients without risk factors had a hazard ratio of 0.70 (95% CI 0.49-0.99) for recurrence compared to risk factor patients. The multivariate hazard ratios for reablation or adverse events/death were not different between the two groups. Hypertension and body mass index were univariate predictors of recurrence. CONCLUSIONS:Patients with ≥1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations and adverse events or death.
Authors: Amaya García-Fernández; María Asunción Esteve-Pastor; Inmaculada Roldán-Rabadán; Javier Muñiz; Martín Ruiz Ortiz; Ángel Cequier; Vicente Bertomeu-Martínez; Lina Badimón; Déborah Otero; Manuel Anguita; Gregory Y H Lip; Francisco Marín Journal: Ann Med Date: 2020-06-17 Impact factor: 4.709