Influence of risk factors in the ESC‐EHRA EORP atrial fibrillation ablation long‐term registry

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.

2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)

“…Strict control of risk factors and avoidance of triggers are recommended as part of a rhythm control strategy 636,637. I B…”

Relationship of adverse events to quality of anticoagulation control in atrial fibrillation patients with diabetes: real-world data from the FANTASIIA Registry

“…prevalence of concomitant risk factors and other diseases (as expressed by higher Charlson index) could make physicians less prone to indicate cardioversion or ablation, given that the presence of one or more risk factors increases the risk of arrhythmia recurrence after ablation by 30% [28]. There is also a lower success rate of both cardioversion and subsequent maintenance of sinus rhythm in patients with DM [29], with a possible relationship to glycaemic control [30].…”

Obstructive Sleep Apnea and Cardiac Arrhythmias: A Contemporary Review

“…While altruistic, routine screening of patients with rhythm disorders may also provide insight regarding rhythm management as well, particularly among patients with treatment-resistant rhythm disorders. Obesity and OSA are tightly linked to one another, and both conditions have been recognized as contributors to the reoccurrence of atrial fibrillation after both cardioversion and successful catheter-based ablation [68,69]. The presence of OSA has been associated with a greater rotor burden in patients with atrial fibrillation, with a proclivity for right atrial rotors in particular [70].…”