Impact of carotid atherosclerosis on arrhythmia recurrence following atrial fibrillation catheter ablation

BACKGROUND: It remains unclear whether carotid atherosclerosis (CAS) increases the atrial fibrillation (AF) recurrence rate after ablation. The aim was to assess the association between CAS, defined as carotid intima-media thickness (CIMT) ≥1 mm and or presence of carotid plaques, and AF recurrence rate after ablation. METHODS: We retrospectively collected patients who underwent carotid ultrasonography and AF ablation at the First Affiliated Hospital of Zhengzhou University. The AF recurrence was defined as documented atrial arrhythmias over 30 s on ECG or 24-h Holter monitoring after the first three months blanking period. Cox regression models were used to analyze the risk of AF recurrence. RESULTS: Overall, 385 patients were analyzed (mean age, 60.58±10.98 years old; female, 41.30%; persistent AF, 47.27%). After a follow-up of 1 year, 138 (35.84%) patients experienced recurrence, Kaplan-Meier analysis showed that patients with the presence of carotid plaques, CIMT ≥1 mm, and CAS had a higher risk of recurrence compared with the absence (all log-rank p < .05). In multivariate Cox regression analysis, CAS (HR 2.159, ±95% CI 1.320-3.532, p = .002), carotid plaque (HR 1.815, ±95%CI 1.160-2.841, p = .009), and CIMT ≥1 mm (HR 1.696, ±95%CI 1.192-2.413, p = .003) were independently associated with a higher risk of recurrence. In subgroup analysis, the association of CAS, carotid plaque, and AF recurrence rate was weaker in men than women. CONCLUSION: Carotid atherosclerosis, CIMT ≥1 mm, and carotid plaque were significantly associated with a higher AF recurrence rate after radiofrequency catheter ablation. They were all risk factors for the recurrence of AF.