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. 2016 Sep 9;5(9):e003183.
doi: 10.1161/JAHA.115.003183.

Age-Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

Yasushi Matsuzawa  1 , Mahmoud Suleiman  2 , Raviteja R Guddeti  1 , Taek-Geun Kwon  1 , Kristi H Monahan  1 , Lilach O Lerman  3 , Paul A Friedman  1 , Amir Lerman  4
Affiliations

Age-Dependent Predictive Value of Endothelial Dysfunction for Arrhythmia Recurrence Following Pulmonary Vein Isolation

Yasushi Matsuzawa et al. J Am Heart Assoc. .

Abstract

Background: The mechanisms of atrial fibrillation (AF) are highly divergent. The prevalence of AF increases significantly with age, and underling mechanisms might vary with age. Endothelial dysfunction may be associated with AF and atrial arrhythmia recurrence after catheter ablation. We tested the hypothesis that the impact of endothelial dysfunction on arrhythmia recurrence following catheter ablation is age dependent.

Methods and results: This study enrolled 92 participants with AF undergoing catheter ablation. Endothelial function was assessed by peripheral arterial tonometry before ablation, and the natural logarithmic transformation of reactive hyperemia index was calculated. Endothelial dysfunction was defined as a natural logarithmic transformation of reactive hyperemia index <0.618 (median). Participants were followed for atrial tachycardia, flutter, and fibrillation recurrence for a median of 14 months. The mean age was 57±10 years. There was significant interaction between age and endothelial dysfunction in association with recurrence of AF (P=0.029) and any atrial arrhythmia (P=0.015), and the risk associated with endothelial dysfunction for arrhythmia recurrence was higher in younger versus older participants. Participants were divided into 2 age groups at a threshold of 60 years. Among participants aged ≤60 years, multivariate Cox proportional hazards analysis revealed the independent association between endothelial dysfunction and increased risk of arrhythmia recurrence (hazard ratio for AF 4.18 [95% CI 1.33-15.82], P=0.014, and for any atrial arrhythmia 3.62 [95% CI 1.29-11.81], P=0.014). Kaplan-Meier analysis showed that participants with endothelial dysfunction had significantly higher rates of recurrence of AF (P=0.01) and any atrial arrhythmia (P=0.002).

Conclusions: The risk associated with endothelial dysfunction for arrhythmia recurrence following catheter ablation was age dependent and was higher in younger participants.

Keywords: catheter ablation; endothelium; fibrillation; follow‐up study.

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Figures

Figure 1
Figure 1
Study design. AF indicates atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; IQR, interquartile range; RH‐PAT, reactive hyperemia–peripheral arterial tonometry.
Figure 2
Figure 2
HRs of endothelial dysfunction for incident AF and atrial arrhythmia recurrence by age groups. The HRs were calculated for Ln_RHI <0.618. The vertical lines through the HRs represent 95% CIs in predicting AF recurrence (A) and any atrial arrhythmia recurrence (B). There is significant interaction between age and endothelial dysfunction in association with arrhythmia recurrence. The risk associated with endothelial dysfunction for arrhythmia recurrence is higher in younger versus older participants. AF indicates atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; HR, hazard ratio; Ln_RHI, natural logarithmic transformation of reactive hyperemia index.
Figure 3
Figure 3
Kaplan–Meier analysis for the probability of AF and atrial arrhythmia recurrence according to baseline endothelial function in participants aged ≤60 years in predicting AF recurrence (A) and any atrial arrhythmia recurrence (B). AF indicates atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; Ln_RHI, natural logarithmic transformation of reactive hyperemia index.
Figure 4
Figure 4
Hazard ratios of endothelial dysfunction for incident AF and atrial arrhythmia recurrence within 3 months after ablation by age group (as in Figure 2). The HRs were calculated for Ln_RHI <0.618. The vertical lines through the HRs represent 95% CIs in predicting AF recurrence (A) and any atrial arrhythmia recurrence (B). AF indicates atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; HR, hazard ratio; Ln_RHI, natural logarithmic transformation of reactive hyperemia index.
Figure 5
Figure 5
Kaplan–Meier analysis for the probability of AF and atrial arrhythmia recurrence within 3 months after ablation according to baseline endothelial function in participants aged ≤60 years (as in Figure 3) in predicting AF recurrence (A) and any atrial arrhythmia recurrence (B). AF indicates atrial fibrillation; AFL, atrial flutter; AT, atrial tachycardia; Ln_RHI, natural logarithmic transformation of reactive hyperemia index.
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