Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(7), 801–809. https://doi.org/10.1002/clc.24036 Dr. Ming-Yang Gao et al.
Points
- Limited evidence on catheter ablation (CA) outcomes for atrial fibrillation (AF) in patients with autoimmune disease (AD) prompted this study.
- Researchers conducted a retrospective analysis of AF ablation cases from 2012 to 2021, comparing recurrence risks in AD patients to a matched non-AD group using propensity score matching.
- Despite more severe AF-related symptoms in AD patients, the risk of AF recurrence during follow-up was similar to non-AD patients (41.1% vs. 36.2%), although early recurrence rates were higher (36.4% vs. 13.5%).
- Connective tissue disease within AD patients was associated with an increased risk of recurrence (46.3% vs. 36.2%).
- Independent predictors of post-ablation recurrence in AD patients included the duration of AF history and corticosteroid therapy, highlighting the need for further research to understand the impact of AD on AF treatment outcomes.
Summary
In this research paper, the authors investigated the outcomes of catheter ablation (CA) for atrial fibrillation (AF) in patients with autoimmune diseases (AD), an area with limited available evidence. They hypothesized that patients with AD might experience worse outcomes following CA procedures for AF. To explore this, a retrospective analysis was conducted on patients who underwent AF ablation between 2012 and 2021. The study evaluated the risk of AF recurrence after ablation in patients with AD and compared them to a matched non-AD group using a 1:4 propensity score matching approach.
The study identified 107 patients with AD, with an average age of 64 years and a majority being female (48.6%), who were then carefully matched with 428 non-AD patients (average age of 65 years, 43.9% female). It was observed that patients with AD exhibited more severe AF-related symptoms. During the initial procedure, more AD patients received nonpulmonary vein trigger ablation (18.7% vs. 8.4%, p = 0.002). Over a median follow-up period of 36.3 months, patients with AD displayed a similar risk of AF recurrence compared to the non-AD group (41.1% vs. 36.2%, p = 0.21, hazard ratio [HR]: 1.23, 95% confidence interval [CI]: 0.86–1.76), despite a notably higher incidence of early recurrences (36.4% vs. 13.5%, p = 0.001). Interestingly, patients with connective tissue disease among those with AD had a higher risk of recurrence than non-AD patients (46.3% vs. 36.2%, p = 0.049, HR: 1.43, 95% CI: 1.00–2.05). Multivariate analysis revealed that the duration of AF history and corticosteroid therapy were independent predictors of post-ablation recurrence in patients with AD.
In conclusion, this study suggests that in patients with AD, the risk of AF recurrence following ablation is comparable to that of non-AD patients during the follow-up period. However, a heightened risk of early recurrence was observed. These findings highlight the need for further research to thoroughly examine the impact of AD on AF treatment outcomes and better understand the factors contributing to recurrent AF in these patients.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24036
References Gao, M., Huang, L., Lai, Y., Guo, Q., Guo, X., Li, S., Jiang, C., Liu, N., He, L., Li, X., Tang, R., Du, X., Long, D., Sang, C., Dong, J., & Ma, C. (2023). Catheter ablation of atrial fibrillation in patients with autoimmune disease: A propensity score matching study based on the China Atrial Fibrillation Registry. Clinical Cardiology, 46(7), 801–809. https://doi.org/10.1002/clc.24036
