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

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.