Clinical and socioeconomic factors associated with recurrent atrial fibrillation after catheter ablation or antiarrhythmic drug therapy

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart Rhythm O2 Pub Date : 2025-05-01 DOI:10.1016/j.hroo.2025.02.007

Jaejin An PhD , Nisha Bansal MD , Chengyi Zheng PhD , Ming-Sum Lee MD, PhD , Rong Wei MA , Teresa N. Harrison SM , Dongjie Fan MS , Elisha Garcia MS , Benjamin Lidgard MD , Leila R. Zelnick PhD , Daniel E. Singer MD , Alan S. Go MD

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Abstract

Background

Maintaining sinus rhythm after initiating rhythm control strategies in atrial fibrillation (AF) remains challenging.

Objective

The study sought to investigate risk factors associated with AF recurrence among patients with incident AF who underwent catheter ablation or received antiarrhythmic drugs (AADs).

Methods

We identified adults with incident AF from 2010 to 2017 who underwent catheter ablation or initiated AAD therapy from 2 U.S. healthcare systems and were followed through 2019. Using electronic health records and a validated natural language processing algorithm, we evaluated the 12-month cumulative incidence of recurrent AF and examined the associations between clinical and socioeconomic factors and AF recurrence using Fine-Gray subdistribution hazard models.

Results

Among 982 patients who underwent catheter ablation and 18,025 who initiated AAD therapy, the 12-month incidence of recurrent AF was 55.5% and 62.7%, respectively, with median times to AF recurrence of 168 and 24 days, respectively. Heart failure was associated with AF recurrence after catheter ablation (adjusted hazard ratio [aHR] 1.41, 95% confidence interval [CI] 1.09–1.81) and AAD therapy (aHR 1.30, 95% CI 1.25–1.36). Low educational attainment (aHR 1.42, 95% CI 1.04–1.95) and higher low-density lipoprotein cholesterol (for ≥100 mg/dL vs 70–99 mg/dL: aHR 1.26, 95% CI 1.02–1.57) were associated with AF recurrence following catheter ablation; obesity (for body mass index ≥40 kg/m² vs <25 kg/m²: aHR 1.27, 95% CI 1.17–1.38), hypertension (aHR 1.08, 95% CI 1.03–1.14), and lower estimated glomerular filtration rate (for 45–59 mL/min/1.73 m² vs ≥60 mL/min/1.73 m²: aHR 1.08, 95% CI 1.03–1.14) were associated with AF recurrence following AAD initiation.

Conclusion

Heart failure, dyslipidemia, obesity, hypertension, reduced estimated glomerular filtration rate, and living in neighborhoods with low educational attainment were associated with higher risk for AF recurrence, emphasizing the importance of identifying and managing modifiable factors in AF.

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导管消融或抗心律失常药物治疗后房颤复发的临床和社会经济因素

背景：心房颤动（AF）患者启动心律控制策略后维持窦性心律仍然具有挑战性。目的：探讨经导管消融或接受抗心律失常药物（AADs）治疗的房颤复发的相关危险因素。方法：我们从2010年至2017年在美国2个医疗保健系统中接受导管消融或开始AAD治疗的成人AF事件中确定，并随访至2019年。使用电子健康记录和经过验证的自然语言处理算法，我们评估了12个月房颤复发的累积发病率，并使用Fine-Gray亚分布风险模型检查了临床和社会经济因素与房颤复发之间的关系。结果在982例导管消融患者和18025例AAD治疗患者中，12个月房颤复发发生率分别为55.5%和62.7%，房颤复发的中位时间分别为168天和24天。心衰与导管消融后房颤复发相关（校正危险比[aHR] 1.41, 95%可信区间[CI] 1.09-1.81）和AAD治疗后房颤复发相关（aHR 1.30, 95% CI 1.25-1.36）。低教育程度（aHR 1.42, 95% CI 1.04-1.95）和较高的低密度脂蛋白胆固醇（≥100 mg/dL vs 70-99 mg/dL: aHR 1.26, 95% CI 1.02-1.57）与导管消融后房颤复发相关；肥胖（体重指数≥40 kg/m2 vs 25 kg/m2: aHR 1.27, 95% CI 1.17-1.38）、高血压（aHR 1.08, 95% CI 1.03-1.14）和较低的肾小球滤过率（45-59 mL/min/1.73 m2 vs≥60 mL/min/1.73 m2: aHR 1.08, 95% CI 1.03-1.14）与AAD发病后AF复发相关。结论心衰、血脂异常、肥胖、高血压、肾小球滤过率降低以及居住在教育程度低的社区与房颤复发风险升高相关，强调识别和管理房颤可改变因素的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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