The following is a summary of “Prevalence and Impact of Poorly Controlled Modifiable Risk Factors Among Patients Who Underwent Atrial Fibrillation Ablation,” published in the July 2023 issue of the Cardiovascular Disease by Stout et al.
The optimization of risk factors (RFs) associated with atrial fibrillation (AF) has been shown to enhance the outcomes of ablation procedures in patients who are obese. However, data from real-world scenarios, including patients not classified as obese, are limited in availability. This study investigated the modifiable risk factors of consecutive patients who underwent atrial fibrillation ablation at a tertiary care hospital between 2012 and 2019. The predetermined risk factors comprised of a body mass index (BMI) equal to or greater than 30 kg/m2, a fluctuation in BMI of more than 5%, obstructive sleep apnea with noncompliance to continuous positive airway pressure, hypertension that is not under control, diabetes that is not under control, hyperlipidemia that is not under control, tobacco use, alcohol use exceeding the recommended limit, and a diagnosis-to-ablation time (DAT) exceeding 1.5 years.
The primary outcome measure consisted of a composite endpoint comprising the recurrence of arrhythmia, admissions related to cardiovascular issues, and cardiovascular mortality. This study noted a significant occurrence of pre-ablation modifiable risk factors (RFs). Over 50% of the 724 participants in the study exhibited uncontrolled hyperlipidemia, a body mass index (BMI) equal to or greater than 30 mg/m2, a fluctuating BMI exceeding 5%, or a delayed dopamine transporter response. During a median follow-up of 2.6 (interquartile range 1.4 to 4.6) years, 467 patients (64.5%) exhibited the primary outcome. The presence of independent risk factors included a significant fluctuation in BMI greater than 5% (hazard ratio [HR] 1.31, P = 0.008), diabetes with an A1c level of 6.5% or higher (HR 1.50, P= 0.014), and uncontrolled hyperlipidemia (HR 1.30, P= 0.005). A cumulative of 264 patients (36.46%) exhibited a minimum of 2 of these predictive risk factors correlated with an elevated occurrence of the primary outcome.
The ablation outcome remained unchanged despite a delay in the performance of the DAT for a period exceeding 1.5 years. In summary, many patients who underwent atrial fibrillation ablation exhibit potentially modifiable risk factors that were inadequately managed. Fluctuating body mass index (BMI), presence of diabetes with hemoglobin A1c levels ≥6.5%, and uncontrolled hyperlipidemia indicate a heightened likelihood of experiencing recurring arrhythmia, requiring hospitalization for cardiovascular issues, and facing an increased risk of mortality following ablation.