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. 2024 Apr 16;13(8):e033740.
doi: 10.1161/JAHA.123.033740. Epub 2024 Apr 10.

Periodontal Treatment During the Blanking Period Improves the Outcome of Atrial Fibrillation Ablation

Shunsuke Miyauchi  1   2 , Kazuhisa Ouhara  3 , Tomoaki Shintani  4 , Takehito Tokuyama  1 , Yousaku Okubo  1 , Sho Okamura  1 , Shogo Miyamoto  1 , Naoto Oguri  1 , Yukimi Uotani  1 , Tasuku Takemura  3 , Misako Tari  3 , Toru Hiyama  2 , Mutsumi Miyauchi  5 , Mikihito Kajiya  4 , Noriyoshi Mizuno  3 , Yukiko Nakano  1
Affiliations

Periodontal Treatment During the Blanking Period Improves the Outcome of Atrial Fibrillation Ablation

Shunsuke Miyauchi et al. J Am Heart Assoc. .

Abstract

Background: Periodontitis has not been recognized as a modifiable risk factor for atrial fibrillation (AF). This prospective nonrandomized study investigated whether periodontal treatment improves the AF ablation outcome.

Methods and results: We prospectively enrolled 288 AF patients scheduled to undergo initial radiofrequency catheter ablation. Each patient underwent periodontal inflamed surface area (PISA; a quantitative index of periodontal inflammation) measurement. All eligible patients were recommended to receive periodontal treatment within the blanking period, and 97 consented. During the mean follow-up period of 507±256 days, 70 (24%) AF recurrences were documented. Patients who exhibited AF recurrences had a higher PISA than those who did not (456.8±403.5 versus 277.7±259.0 mm2, P=0.001). These patients were categorized into high-PISA (>615 mm2) and low-PISA (<615 mm2) groups according to the receiver operating characteristic analysis for AF recurrence (area under the curve, 0.611; sensitivity, 39%; specificity, 89%). A high PISA, as well as female sex, AF duration, and left atrial volume, were the statistically significant predicter for AF recurrence (hazard ratio [HR], 2.308 [95% CI, 1.234-4.315]; P=0.009). In patients with a high PISA, those who underwent periodontal treatment showed significantly fewer AF recurrences (P=0.01, log-rank test). The adjusted HR of periodontal treatment for AF recurrence was 0.393 (95% CI, 0.215-0.719; P=0.002).

Conclusions: Periodontitis may serve as a modifiable risk factor for AF. PISA is a hallmark of AF recurrence, and periodontal treatment improves the AF ablation outcome, especially for those with poor periodontal condition.

Keywords: modifiable risk factor; periodontal inflamed surface area; periodontitis; radiofrequency catheter ablation; recurrence.

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Figures

Figure 1
Figure 1. Flowchart of participant selection.
This single‐center prospective, nonrandomized study enrolled 330 patients who were scheduled to undergo initial RFCA. Periodontal examination was performed 1 day before RFCA, and periodontal inflammation was quantified by PISA. Patients were divided into the periodontal treatment group and nontreatment group according to their intentions before RFCA. Nonsurgical periodontal treatment was conducted during the blanking period only in the treatment group. We excluded 42 patients and included 288 patients (treatment group, n=97; nontreatment group, n=191) in the analysis. *Patients who were lost to follow‐up before the 6‐month outpatient visit. AF indicates atrial fibrillation; PISA, periodontal inflamed surface area; RFCA, radiofrequency catheter ablation; TEE, transesophageal echocardiography; and TTE, transthoracic echocardiography.
Figure 2
Figure 2. Relationship between PISA and AF recurrence.
Association of PISA with AF recurrence (A–D) was analyzed in the nontreatment group (n=191). A, PISA and early AF recurrence (360.9±372.1 vs 296.6±272.9 mm2, P=0.21). B, PISA and AF recurrence within 12 months (456.8±403.5 vs 277.7±259.0 mm2; P=0.001). C, The receiver operating characteristic analysis of PISA for AF recurrence within 12 months. Patients were divided into high‐ and low‐PISA groups on the basis of the cutoff value of 615 mm2. D, The Kaplan–Meier analysis of AF recurrence between high‐ and low‐PISA groups. E, Serum hs‐CRP levels between the high‐ and low‐PISA groups (0.09 [IQR, 0.05–0.20] vs 0.06 [IQR, 0.03–0.11] mg/dL; P=0.005, Wilcoxon rank‐sum test, analyzed among all patients [N=288]). AF indicates atrial fibrillation; AUC, area under the curve; hs‐CRP, high‐sensitivity C‐reactive protein; and PISA, periodontal inflamed surface area.
Figure 3
Figure 3. PISA and inflammatory cytokines/chemokines.
Serum levels of inflammatory cytokines and chemokines were compared between the high‐ and low‐PISA groups and analyzed using the Wilcoxon rank‐sum test. IL indicates interleukin; MCP‐1, monocyte chemoattractant protein‐1; PISA, periodontal inflamed surface area; and TNF‐α, tumor necrosis factor‐ α.
Figure 4
Figure 4. Periodontal treatment and AF recurrence.
A, PISA was improved by the periodontal treatment during the blanking period (614.3±457.2–322.0±295.2 mm2). B through D, Kaplan–Meier analysis of AF recurrence between the treatment and nontreatment groups. B, All patients (N=288); C, high PISA (>615 mm2) group (n=71); D, low PISA (<615 mm2) group (n=217). Results of the log rank tests were presented for AF recurrences within 12 months and the follow‐up period. AF indicates atrial fibrillation; and PISA, periodontal inflamed surface area.
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