Impact of periodontitis as representative of chronic inflammation on long-term clinical outcomes in patients with atrial fibrillation

Abstract

Objectives: Relationship between atrial fibrillation (AF) and inflammation was shown in previous studies. However, there was limited data about the association between the periodontitis and AF in the long-term follow-up. The aim of this study was to evaluate the impact of periodontitis on long-term clinical outcomes in patients with AF.

Methods: The Kosin University echocardiography, ECG and periodontitis database were reviewed from 2013 to 2015 to identify patients with AF. Those patients were divided into two groups according to the presence of periodontitis and clinical events including any arrhythmic attack, thromboembolic and bleeding and death were collected during a median of 18 months.

Results: Among 227 patients with AF, 47 (20.7%) patients had periodontitis. Major adverse cardiac events (MACE) were significantly higher in patients with periodontitis compared with those without periodontitis (p<0.001). Arrhythmias including AF, atrial tachycardia, atrial premature beat, ventricular tachycardia and ventricular premature beat also occurred in 44 (93.6%) patients, which was higher significantly higher incidence in patients with periodontitis than in those without periodontitis (p<0.001). In univariate analysis, age, CHA₂DS₂-VASc, left atrial volume index (LAVi) and periodontitis were significantly associated with arrhythmic events and MACE including bleeding events, thromboembolic events, arrhythmic events and mortality. In multivariate analysis, LAVi (p=0.005) and periodontitis (p<0.001) were independent risk factors for arrhythmic events and periodontitis (p<0.001) for MACE at the long-term follow-up.

Conclusions: The periodontitis as representative of chronic inflammation was an independent predictor of arrhythmic events and MACE in patients with AF.

Keywords: arrhythmias; atrial fibrillation; inflammation.

Figure 1

Flow diagram. AF, atrial fibrillation.

Figure 2

Kaplan-Meier analysis for event-free survival in patients with atrial fibrillation according to the presence of periodontitis: (A) major adverse cardiac events including bleeding events, thromboembolic events, arrhythmic events and mortality; (B) arrhythmic events.