Key result
Enalapril-folic acid linked to ~32% lower AF recurrence versus enalapril alone post-ablation in H-type hypertension.
Why the study?
Elevated serum total homocysteine strongly correlates with AF recurrence, but whether folic acid treatment reduces AF recurrence after radiofrequency catheter ablation remains unclear.
Does folic acid supplementation combined with enalapril reduce atrial fibrillation recurrence in H-type hypertensive patients after first radiofrequency catheter ablation compared to enalapril alone?
Cohort (n=927)
No
Does folic acid supplementation combined with enalapril reduce atrial fibrillation recurrence in H-type hypertensive patients after first radiofrequency catheter ablation compared to enalapril alone?
Folic acid supplementation combined with enalapril significantly reduces the risk of atrial fibrillation recurrence after first radiofrequency catheter ablation in H-type hypertensive patients.
Enalapril-folic acid was associated with lower post-ablation AF recurrence in H-type hypertension; leaves open need for randomized confirmation before practice change.
Background Prior investigation revealed that elevated serum total homocysteine (tHcy) are strongly correlated with atrial fibrillation (AF) recurrence. Herein, the goal of this study was to elucidate whether folic acid (FA) treatment reduced AF recurrence following radiofrequency catheter ablation (RFCA). Methods To conduct this retrospective research, we included consecutive H-type hypertensive AF patients, who were treated with first RFCA, between January 2010 and January 2022. We assessed the AF recurrence risk between patients who were taking 10 mg enalapril and 0.8 mg FA in a single-pill combination (enalapril–FA) daily and those who were taking a pill of 10 mg enalapril only. Outcomes were compared using the propensity-score matched analysis. Cox regression model was employed for the evaluation of AF recurrence events. Results Out of 2,714 patients, 645 patients receiving enalapril and 282 patients receiving enalapril-FA were included for analysis. Following propensity score matching, 239 patients remained in each group. These patients were followed-up for a median of 379 (137–596) days, and revealed that the enalapril-FA patients had drastically reduced AF recurrence, compared to the enalapril patients [adjusted hazard ratio (HR), 0.68; 95% confidence interval (CI), 0.48–0.97; P = 0.029]. Apart from this, no interactions were detected in the subgroup analysis. Conclusion In H-type hypertensive AF patients who were treated with first RFCA, FA supplementation was correlated with a reduced AF recurrence risk.
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Dong et al. (2022) conducted a cohort in H-type hypertension with atrial fibrillation (n=927). Enalapril-folic acid vs. Enalapril 10 mg daily was evaluated on Atrial fibrillation recurrence (HR 0.68, 95% CI 0.48-0.97, p=0.029). In H-type hypertensive patients with atrial fibrillation undergoing first radiofrequency catheter ablation, enalapril-folic acid supplementation significantly reduced the risk of AF recurrence (HR 0.68) compared to enalapril alone.
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