No abstract

Background Atrial fibrillation (AF) has become a global epidemic. Early catheter ablation and therapies modifying risk factors (RF) have been shown to improve outcomes of AF ablation. However, the time invested in pursuing risk factor modification may delay ablation, which could negate the procedural benefit. Purpose This study sought to investigate the prevalence and impact of potentially modifiable RF among AF patients undergoing catheter ablation in clinical practice. Methods This retrospective study included 724 consecutive patients undergoing AF ablation at a tertiary care center from 2012–2019. Pre-specified modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation/increase in BMI >5% prior to ablation, mean systolic/diastolic blood pressure >125/80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) >6.5%. The primary outcome was a composite of recurrent atrial arrhythmias, cardiovascular (CV) hospitalizations and mortality following AF ablation. A multivariate analysis was performed. Results The mean age was 61±10 years old, 32.5% were female and 72.2% had persistent AF. Many study patients had modifiable RF, ranging from 4.7% with excessive alcohol use to 64.0% experiencing delayed AF ablation. The mean time from AF diagnosis to ablation was 4.7 years. During a mean follow-up of 1.6 years after ablation, 467 (64.5%) patients met the primary outcome. Independent RF for the primary outcome were an increase/fluctuation in BMI >5% (adjusted hazard ratio [AHR] 1.31, 95% confidence interval [CI] 1.07–1.60; P=0.008), diabetes with HbA1c >6.5% (AHR 1.50, 95% CI 1.09–2.03; P=0.014) and hyperlipidemia without statin therapy (AHR 1.30, 95% CI 1.08–1.57; P=0.005). Delayed AF ablation over 1.5 years did not alter the outcome, Figure 1. Conclusion Substantial portions of patients undergoing AF ablation have potentially modifiable RF. Increased or fluctuating BMI, diabetes with HbA1c >6.5%, and hyperlipidemia not treated with statin therapy portend an increased risk of recurrent atrial arrhythmia, CV hospitalizations and mortality. These findings underscore an importance pursuing RF management in patients with AF to reduce adverse outcomes after ablation. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Jensen Family Research Sponsorship at the University of Nebraska Medical Center

Purpose: Managing atrial fibrillation (AF) risk factors (RF) improves ablation outcomes in obese patients. However, real-world data including non-obese patients is limited. Methods: Pre-specified modifiable RFs among 724 consecutive patients undergoing AF ablation at a tertiary care hospital from 2012 to 2019 were examined. These included body mass index (BMI) ≥ 30 kg/m2, > 5% fluctuation in BMI, obstructive sleep apnea with continuous positive airway pressure non-compliance, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hyperlipidemia, tobacco use, alcohol use above the standard recommendation, and a diagnosis-to-ablation time (DAT) > 1.5 years. The primary outcome was a composite of arrhythmia recurrence, cardiovascular admissions, and cardiovascular death. Results: We identified a high prevalence of pre-ablation modifiable RFs with more than 50% of the study patients experiencing uncontrolled HLD, BMI ≥ 30 mg/m2, fluctuating BMI > 5% or experiencing delayed DAT. During a median follow-up of 2.6 (interquartile range 1.4, 4.6) years, 467 (64.5%) patients met the primary outcome. Independent RFs were a fluctuation in BMI > 5% (hazard ratio [HR] 1.31; P = 0.008), diabetes with A1c ≥ 6.5% (HR 1.50; P = 0.014) and uncontrolled hyperlipidemia (HR 1.30; P = 0.005). A total of 264 (36.46%) patients had at least two of these predictive RFs, which was associated with higher incidence of the primary outcome. Delayed DAT over 1.5 years did not alter the ablation outcome. Conclusions: Substantial portions of patients undergoing AF ablation have potentially modifiable RFs that were not well controlled. Fluctuating BMI, diabetes with HbA1c ≥ 6.5%, and uncontrolled HLD portend an increased risk of recurrent arrhythmia, CV hospitalizations and mortality following ablation.