Predictive value of valvular calcification for the recurrence of persistent atrial fibrillation after radiofrequency catheter ablation

Abstract

BackgroundValvular calcification (VC) is an independent risk factor for cardiovascular diseases. The relationship between VC and atrial fibrillation is not clear.HypothesisWe treated the aortic valve, mitral valve, and tricuspid valve as a whole and considered the possible association between VC and recurrence of persistent atrial fibrillation (PsAF) after radiofrequency catheter ablation (RFCA).MethodsThis study involved 2687 PsAF patients who underwent RFCA. Data were collected to explore the relationship between VC and outcome. VC was defined by echocardiography in aortic valve, mitral valve, or tricuspid valve. After 1 year follow‐up, subgroup analysis, mixed model regression analysis, and score system analysis were performed. The external validation of 133 patients demonstrated the accuracy of this clinical prediction model.ResultsOverall, 2687 inpatients were assigned to the recurrence group (n = 682) or the no recurrence group (n = 2005) with or without VC. Compared to patients with no recurrence, the incidence of VC was higher in recurrence patients. Recurrence was present in 18.5%, 34.9%, 39.3%, and 52.0% of the four groups, which met VC numbers of 0, 1, 2, and 3, respectively. After adjustment for potential confounding factors, VC was an independent risk factor for AF recurrence in several models. For multivariable logistic regression, a scoring system was established based on the regression coefficient. The receiver operating characteristic area of the scoring system was 0.787 in the external validation cohort.ConclusionsVC was an independent risk factor for AF recurrence in PsAF after RFCA. The scoring system may be a useful clinical tool to assess AF recurrence.

Detailed causality between the valvular calcification and recurrent atrial fibrillation after catheter ablation

“…Additionally, the authors could shed light on why calcification of the pulmonary valve did not exhibit an association with recurrent atrial fibrillation. 1 The exclusion of individuals with rheumatic heart disease raises methodological questions. 1 Further elaboration on the methodology for their exclusion would be beneficial, particularly considering the challenges in distinguishing rheumatic valvular disease from other forms of valvular pathologies.…”

“…1 The exclusion of individuals with rheumatic heart disease raises methodological questions. 1 Further elaboration on the methodology for their exclusion would be beneficial, particularly considering the challenges in distinguishing rheumatic valvular disease from other forms of valvular pathologies. Notably, rheumatic fever can give rise not only to mitral stenosis but also to mitral regurgitation.…”

“…2 In the study, the authors dichotomized the presence of valvular calcification. 1 While acknowledging that computed tomography stands as the gold standard for quantifying cardiac calcification, 3 it would be advantageous if the authors quantified the degree of valvular calcification, treating them as continuous variables. Otherwise, assuming approximately 90% of the participants had no valvular calcification could raise concerns regarding the accuracy of their conclusions.…”

“…Otherwise, assuming approximately 90% of the participants had no valvular calcification could raise concerns regarding the accuracy of their conclusions. 1 Addressing the practical implications of their findings is pivotal. 1 It would be valuable for the authors to propose potential therapeutic or prophylactic strategies for individuals with valvular calcification.…”

“…1 Addressing the practical implications of their findings is pivotal. 1 It would be valuable for the authors to propose potential therapeutic or prophylactic strategies for individuals with valvular calcification.…”