PO-01-097 HYPERLIPIDEMIA AS A PREDICTIVE RISK FACTOR OF ATRIAL ARRYTHMIA RECURRENCE FOLLOWING ABLATION: A DECAAF II SUBSTUDY

Abstract

Multiple co-morbidities are known risk factors in atrial fibrillation (AF) recurrence following pulmonary vein isolation (PVI). Our aim was to assess the effect of hyperlipidemia (HLD) and statin therapy on atrial arrhythmia (AA) recurrence in persistent atrial fibrillation (PrAF) pts undergoing an initial PVI procedure. The DECAAF II trial was a prospective randomized controlled study evaluating the efficacy of MRI-guided fibrosis ablation compared to conventional ablation. Patient demographics, co-morbidities, medication regimens, baseline left atrial volume and atrial fibrosis were collected prior to ablation. After the procedure and 90-day blanking period, each participant submitted an ECG strip daily or when experiencing symptoms. A total of 826 pts were included, completed adequate follow up and had data regarding their HLD status. These pts were subsequently assessed for recurrent AA for 365 days post procedure. For this substudy, each patient was stratified into a HLD and non-HLD group irrespective of treatment modality. A covariate adjusted Cox regression model was used to assess determinants of AA recurrence. Lastly, a cox regression analysis was performed in patients taking HLD to assess for the effect of statins on AA recurrence. In the respective non-HLD and HLD groups, there was no statistical difference in mean left atrial volume (130±42 vs 135±38cc, p=0.08) and baseline fibrosis (19.0±7.4 vs 18.6±7.5%, p=0.43). However, there were statistically significant differences in age (61±9 vs 65±8 years, p=0.001), underlying hypertension (53.1 vs 69.1%, p=0.0001), diabetes (7.4 vs 14.5%, p=0.001), heart failure (16.8 vs 23.0%, p=.03) and obesity (52.4 vs 63.5%, p=0.002). When adjusted for these co-morbidities summarized in Table 1, analysis demonstrated HLD as a significant risk factor in procedural success and freedom from AA (Figure 1, p=0.02) with a hazard ratio of 1.30 (95% CI 1.05-1.61). Moreover, the use of statin therapy did not impact freedom from AA within the HLD group (Figure 1, p=0.51) with a hazard ratio of 0.83 (95% CI 0.58-1.12) HLD is an independent predictor of AA recurrence in PrAF pts undergoing PVI. However, statin therapy does not seem to improve AA recurrence after PVI in pts with PrAF and HLD.