Abstract
BackgroundRecent community-based research has linked aortic stiffness to the development of atrial fibrillation. We posit that aortic stiffness contributes to adverse atrial remodeling leading to the persistence of atrial fibrillation following catheter ablation in lone atrial fibrillation patients, despite the absence of apparent structural heart disease. Here, we aim to evaluate aortic stiffness in lone atrial fibrillation patients and determine its association with arrhythmia recurrence following radio-frequency catheter ablation.MethodsWe studied 68 consecutive lone atrial fibrillation patients who underwent catheter ablation procedure for atrial fibrillation and 50 healthy age- and sex-matched community controls. We performed radial artery applanation tonometry to obtain central measures of aortic stiffness: pulse pressure, augmentation pressure and augmentation index. Following ablation, arrhythmia recurrence was monitored at months 3, 6, 9, 12 and 6 monthly thereafter.ResultsCompared to healthy controls, lone atrial fibrillation patients had significantly elevated peripheral pulse pressure, central pulse pressure, augmentation pressure and larger left atrial dimensions (all P<0.05). During a mean follow-up of 2.9±1.4 years, 38 of the 68 lone atrial fibrillation patients had atrial fibrillation recurrence after initial catheter ablation procedure. Neither blood pressure nor aortic stiffness indices differed between patients with and without atrial fibrillation recurrence. However, patients with highest levels (≥75th percentile) of peripheral pulse pressure, central pulse pressure and augmentation pressure had higher atrial fibrillation recurrence rates (all P<0.05). Only central aortic stiffness indices were associated with lower survival free from atrial fibrillation using Kaplan-Meier analysis.ConclusionAortic stiffness is an important risk factor in patients with lone atrial fibrillation and contributes to higher atrial fibrillation recurrence following catheter ablation procedure.
Highlights
Atrial fibrillation (AF) has been recognized as an emerging epidemic
Aortic stiffness has been proposed as a novel modifiable risk marker for AF, with increased brachial pulse pressure found to be associated with AF development in the Framingham community-based observational cohort [2]
Radial artery waveform obtained by applanation tonometry can be used to derive the following surrogate measures of aortic stiffness: central systolic blood pressure, central pulse pressure, augmentation pressure and augmentation index
Summary
Atrial fibrillation (AF) has been recognized as an emerging epidemic. Increased focus on its prevention is thereby warranted given the limitations with current therapeutic options [1]. Aortic stiffness has been proposed as a novel modifiable risk marker for AF, with increased brachial pulse pressure found to be associated with AF development in the Framingham community-based observational cohort [2]. This association was stronger than systolic blood pressure alone and remained significant even after adjustment for established predictive factors such as left atrial enlargement and left ventricular hypertrophy [2]. We aim to evaluate aortic stiffness in lone atrial fibrillation patients and determine its association with arrhythmia recurrence following radio-frequency catheter ablation
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