High cardiovascular-kidney-metabolic burden was associated with a significantly higher risk of recurrence after first ablation in patients with persistent atrial fibrillation (HR 1.60).
Cohort (n=730)
No
Does a higher cardiovascular-kidney-metabolic burden increase the risk of recurrence in patients with non-valvular persistent atrial fibrillation undergoing first-time ablation?
Higher cardiovascular-kidney-metabolic burden is independently associated with an increased risk of recurrence after first-time ablation for persistent atrial fibrillation, highlighting the importance of multisystem risk factor management.
Effect estimate: HR 1.60 (95% CI 1.13-2.27)
p-value: p=0.008
Background Recurrence after first radiofrequency catheter ablation remains common in patients with non-valvular persistent atrial fibrillation. Cardiovascular-kidney-metabolic burden may contribute to atrial remodeling and adverse ablation outcomes, but its relationship with post-ablation recurrence and downstream atrial substrate markers remains incompletely understood. Methods We retrospectively enrolled 730 patients with non-valvular persistent atrial fibrillation who underwent first-time radiofrequency catheter ablation. Cardiac, kidney, and metabolic domains were integrated into a weighted cardiovascular-kidney-metabolic burden score, and patients were stratified by tertiles. Sequential Cox regression models were constructed to evaluate the association between burden and recurrence after adjustment for clinical characteristics and downstream atrial substrate markers, including left atrial diameter, log(BNP), and fine f-wave. Model discrimination was assessed using Harrell’s C-index and time-dependent receiver operating characteristic analysis. Results During follow-up, 228 patients (31.2%) developed recurrence. Compared with the low-burden tertile, intermediate- and high-burden tertiles were associated with a significantly higher risk of recurrence in the primary adjusted model (intermediate vs. low: HR = 1.49, 95% CI 1.05–2.11; high vs. low: HR = 1.60, 95% CI 1.13–2.27). Further adjustment for left atrial diameter, log(BNP), and fine f-wave attenuated these associations, suggesting partial statistical overlap between upstream multisystem burden and downstream atrial substrate abnormalities. In continuous analyses, each 1-standard deviation increase in weighted burden remained associated with recurrence risk. Addition of substrate markers improved model discrimination. Conclusion Higher cardiovascular-kidney-metabolic burden was associated with recurrence after first ablation in patients with non-valvular persistent atrial fibrillation, suggesting partial statistical overlap between upstream multisystem burden and downstream atrial substrate abnormalities.
Zheng et al. (Mon,) conducted a cohort in Non-valvular persistent atrial fibrillation (n=730). High cardiovascular-kidney-metabolic (CKM) burden vs. Low CKM burden was evaluated on Post-ablation AF recurrence (HR 1.60, 95% CI 1.13-2.27, p=0.008). High cardiovascular-kidney-metabolic burden was associated with a significantly higher risk of recurrence after first ablation in patients with persistent atrial fibrillation (HR 1.60).