Key result
ACE DD genotype linked to ~125% higher AF recurrence risk after catheter ablation.
Why the study?
The ACE gene insertion/deletion polymorphism's association with AF recurrence after catheter ablation was uncertain despite its link to cardiac fibrosis and anti-AF drug failure.
Cohort (n=238)
Answers are grounded in this paper and cite their sources.
ACE DD genotype was associated with AF recurrence post-ablation; leaves open whether genotyping aids risk stratification before the procedure.
BACKGROUND: The angiotensin-converting enzyme (ACE) deletion allele, ACE D, is associated with increased cardiac ACE activity, cardiac fibrosis, and adverse outcomes in cardiovascular disease and has been linked with failure of antiatrial fibrillation (anti-AF) drug treatment. This study tested the hypothesis that the ACE gene insertion/deletion polymorphism associates with AF recurrence after catheter ablation. METHODS AND RESULTS: In 238 consecutive patients (69% male; mean age, 58±11 years) undergoing catheter ablation of paroxysmal (59%) or persistent (41%) AF, the ACE insertion/deletion polymorphism was genotyped using polymerase chain reaction. After a blanking period of 3 months, AF recurrence (defined as any atrial arrhythmia lasting ≥30 s) was detected using serial 7-day Holter ECG recordings after 3, 6, and 12 months. AF recurrence was observed in 39% and was associated with persistent AF, longer history of AF, previous antiarrhythmic drug use, previous use of diuretics, increased left atrial diameter, increased left ventricular end-diastolic diameter, additional linear ablation lesions, and ACE DD polymorphism. In multivariable analysis, left atrial diameter (odds ratio, 1.111; 95% confidence interval, 1.040-1.187; P=0.002) and ACE DD genotype (odds ratio, 2.251; 95% confidence interval, 1.056-4.798; P=0.036) remained predictors for AF recurrence. CONCLUSIONS: Left atrial enlargement and the ACE DD polymorphism are predictors for AF recurrence after catheter ablation. The association between the ACE DD polymorphism and AF recidivism supports the use of genetic data for predicting response to AF therapies and highlights the role of fibrosis in AF development.
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Ueberham et al. (2013) conducted a cohort in Atrial fibrillation (n=238). ACE DD genotype vs. Non-DD genotype was evaluated on Atrial fibrillation recurrence (any atrial arrhythmia lasting ≥30 s) (OR 2.251, 95% CI 1.056-4.798, p=0.036). The ACE DD genotype was a significant independent predictor of atrial fibrillation recurrence after catheter ablation (OR 2.251; 95% CI 1.056-4.798; P=0.036).
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