What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=151). Intervention: Arterial stiffness. Primary outcome: Recurrence of atrial fibrillation after pulmonary vein isolation (OR 3.6, 95% CI 2.8-4.1).

November 24, 2021Open Access

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

Key Result

Arterial stiffness was identified as an independent predictor of atrial fibrillation recurrence after pulmonary vein isolation (OR 3.6).

Study Design

Type

Observational (n=151)

Multicenter

Structured PICO

Does increased arterial stiffness predict atrial fibrillation recurrence in patients undergoing pulmonary vein isolation?

Population

151 patients with atrial fibrillation who underwent pulmonary vein isolation (PVI), mean age 71.9 ± 9.8 years.

Intervention

Evaluation of arterial stiffness (AS) by measuring aortic distensibility (AD) of the descending aorta via transoesophageal echocardiography

Outcome

Atrial fibrillation recurrence

Increased arterial stiffness and left atrial size are strong independent predictors of atrial fibrillation recurrence following pulmonary vein isolation.

Main Result

Effect estimate: OR 3.6 (95% CI 2.8-4.1)

Limitations

Study population consisted of patients with complicated AF treated at a university hospital, which may have led to a higher proportion of recurrences
Incidence of recurrent AF may have been underestimated in asymptomatic patients
Paroxysmal episodes may not have been detected despite periodic Holter monitoring

Abstract

Abstract Background Arterial 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. Methods Patients 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. Results In 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/m 2 , 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. Conclusion Increased 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 registration German registry for clinical studies (DRKS), DRKS00019007.

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Cite This Study

Shchetynska‐Marinova et al. (Wed,) conducted a observational in Atrial fibrillation (n=151). Arterial stiffness was evaluated on Recurrence of atrial fibrillation after pulmonary vein isolation (OR 3.6, 95% CI 2.8-4.1). Arterial stiffness was identified as an independent predictor of atrial fibrillation recurrence after pulmonary vein isolation (OR 3.6).

synapsesocial.com/papers/6a0ef3e1a14f152feafa10bb https://doi.org/https://doi.org/10.1007/s12471-021-01644-w

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