The association between hyperuricemia and atrial fibrillation recurrence after catheter ablation

Abstract

BackgroundHyperuricemia (HU) has been reported to be associated with a high incidence of atrial fibrillation (AF). However, the relationship between HUA and recurrent AF after catheter ablation (CA) is unclear.MethodsFour hundred consecutive AF patients (paroxysmal/persistent AF [PAF/PsAF]: 200/200) who underwent the initial CA were retrospectively enrolled. HU was defined as serum uric acid (SUA) level >7.0 mg/dL. We measured SUA levels 1 day before (pre‐CA) and 1 month after CA (post‐CA). A second‐generation 28 mm cryoballoon was used for pulmonary vein isolation (PVI) for PAF, while PVI plus linear ablation (roof and mitral isthmus lines) by radiofrequency catheter was conducted for PsAF.ResultsDuring 57 ± 24 months of follow‐up, AF recurred in 16% and 42% in PAF and PsAF patients (p < .0001). Pre‐CA SUA level in PsAF was significantly higher than that in PAF (6.5 ± 1.3 vs. 5.8 ± 1.3 mg/dL, p < .001). SUA level was significantly decreased after CA in both PAF and PsAF (5.8 ± 1.3 vs. 5.6 ± 1.3 mg/dL; p < .01 and 6.5 ± 1.3 vs. 6.1 ± 1.2 mg/dL; p < .0001, respectively). The association between pre−/post‐CA HU and recurrent AF was not identified in PAF, while the incidence of post‐CA HU was significantly higher in patients with recurrent AF than those without in PsAF (36% vs. 15%, p < .001). In multivariable analysis, longer AF duration and the presence of post‐CA HU were identified as independent predictors of AF recurrence in PsAF (OR:1.01, 95%CI:1.003–1.011, p = .0001 and OR:2.77, 95%CI:1.333–5.755, p = .007, respectively).ConclusionsSUA level was significantly higher in PsAF than PAF patients. The presence of post‐CA HU was strongly related to AF recurrence in PsAF patients.

Editorial to “The association between hyperuricemia and atrial fibrillation recurrence after catheter ablation”

“…4 The results of previous studies support that increased uric acid level plays EDITORIAL an active role in the mechanism of atrial remodeling and AF rather than being an innocent bystander. Although the relation of preablation SUA levels alone with AF recurrence after catheter ablation was assessed in previous studies, Oseto et al 1 evaluated the association of serial SUA levels (preablation, post-ablation 1st, 3rd, and 6th months) with AF recurrence after catheter ablation. Only postablation SUA levels rather than preablation SUA levels were found as an independent predictor of AF recurrence after catheter ablation in PeAF patients.…”

“…Only postablation SUA levels rather than preablation SUA levels were found as an independent predictor of AF recurrence after catheter ablation in PeAF patients. Oseto et al 1 showed that post-ablation reduction of the HU rates in PeAF patients was independent of the SUA-lowering medication rates. In parallel to this finding of Oseto et al, Aoyama et al 5 also showed a significant post-ablation reduction in SUA levels independent from inflammatory parameters and kidney functions at 12-month follow-up.…”

Clinical implication of hyperuricemia on the recurrence of atrial fibrillation after catheter ablation

“…Oseto and colleagues have demonstrated a significant elevation in serum uric acid levels among patients with persistent AF compared to those with paroxysmal AF. 1 Moreover, the presence of post‐ablation hyperuricemia has been associated with the recurrence of AF in patients with persistent AF. However, several concerns have been raised.…”

“… 2 In the authors' study, both uric acid and γ‐glutamyl transpeptidase levels were elevated in patients with persistent AF. 1 Elevated γ‐glutamyl transpeptidase levels may be linked to alcohol consumption, which has been associated with the onset and recurrence of AF. 3 It is highly recommended to adjust for these potential confounders to accurately assess the impact of serum uric acid levels on AF recurrence.…”

“…While the authors focused on the association between uric acid and left atrial remodeling, 1 noteworthy that only a small fraction of xanthine oxidase is located in the left atrium. 2 Did the author correlate serum uric acid levels with left atrial size, which may be more appropriate?…”