Recurrence of atrial fibrillation after pulmonary vein isolation in dependence of arterial stiffness.

T Shchetynska-Marinova,I Akin,V Liebe,A L Hohneck,S Rosenkaimer,S Gerhards,S Baumann,M Borggrefe,A Grafen,M Kranert

doi:10.1007/s12471-021-01644-w

Abstract

BackgroundArterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated.MethodsPatients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography.ResultsIn total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0–31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7 × 10−3 mm Hg−1, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m2, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2–3.4) and AS (OR 3.6, 95% CI 2.8–4.1) as independent risk factors of AF recurrence.ConclusionIncreased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence.Trial registrationGerman registry for clinical studies (DRKS), DRKS00019007.Supplementary InformationThe online version of this article (10.1007/s12471-021-01644-w) contains supplementary material, which is available to authorized users.

Highlights

Atrial fibrillation (AF) is the most commonly sustained cardiac rhythm disturbance
aortic distensibility (AD) was significantly correlated with left atrial size, which suggests that increased Arterial stiffness (AS) leads to atrial remodelling and to atrial fibrillation (AF) recurrence
It is recognised that permanent AF, left atrial (LA) size, hypertension, diabetes mellitus, obstructive sleep apnoea, heart failure, and early AF recurrence after pulmonary vein isolation (PVI) [24,25,26,27,28,29] are associated with recurrent AF, which is why multimorbid patients are more likely to be considered at risk of recurrence

Summary

Introduction

Atrial fibrillation (AF) is the most commonly sustained cardiac rhythm disturbance. The prevalence of this age-related condition is still increasing [1, 2]. The treatment options for AF are still improving, especially interventional therapy by catheter ablation or pulmonary vein isolation (PVI), recurrences remain a major challenge. Arterial stiffness was a global parameter of cardiovascular damage, but it was independently associated with recurrent atrial fibrillation. Arterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated

Methods

Results

Discussion

Conclusion