Ablation of Atrial Fibrillation in Patients with Hypertension—An Analysis from the German Ablation Registry

Abstract

Background: Hypertension (HTN) constitutes a risk factor for the development of atrial fibrillation (AF), as well as for thromboembolic and bleeding events. We analysed the outcome after catheter ablation of AF in HTN in a cohort from the prospective multicenter German Ablation Registry. Methods: Between 03/2008 and 01/2010, 626 patients undergoing AF-ablation were analysed. Patients diagnosed with HTN (n = 386) were compared with patients without HTN (n = 240) with respect to baseline, procedural and long-term outcome parameters. Results: Patients with HTN were older and more often presented with persistent forms of AF and cardiac comorbidities. Major and moderate in-hospital complications were low. At long-term follow-up, major cardiovascular events were rare in both groups. Rates of AF-recurrence, freedom from antiarrhythmic medication and repeat ablation were not statistically different between groups. Most patients reported improvement of symptoms and satisfaction with the treatment. However, patients with HTN more frequently complained of dyspnea of New York Heart Association (NYHA) class ≥ II and angina. They were more often rehospitalized, particularly when persistent AF had been diagnosed. Conclusion: Catheter ablation of AF is associated with low complication rates and favorable arrhythmia-related results in patients with HTN. Residual clinical symptoms may be due to cardiac comorbidities and require additional attention in this important subgroup of AF-patients.

Does Preoperative Sinus Rhythm Influence Surgical Ablation’s Perioperative Safety in Patients with Atrial Fibrillation?

“…Moreover, we observe the same for stroke and MACCE [Mack 2019;Mäkikallio 2016;Popma 2019;Serruys 2009;Stone 2016]. Also, no patient in our SR-group suffered a complication, which are more likely to occur in interventional ablations (where it is around 0.5%, i.e., pulmonary vein injury or stenosis, phrenic nerve palsy, vena cava, or esophageal injury [Kany 2021;Rottner 2021;Zylla 2020]). In addition, only 0.3% of patients in the SR group had a pulmonary embolism.…”

Lifestyle Modification and Atrial Fibrillation: Critical Care for Successful Ablation

“…The effect of hypertension on atrial fibrillation recurrence after ablation is influenced by the level of control of this risk factor. Hypertension associates with increased age, more cardiovascular comorbidities, greater likelihood of persistent AF, and was an independent predictor of increased recurrence of AF post-ablation in earlier studies [63][64][65][66]. A more recent study of 626 patients from 55 centres in the German Ablation Registry showed that AF recurrence rates, freedom from antiarrhythmic medication and repeat ablation were not different with versus without hypertension diagnosis at the time of ablation, though there were more reports of dyspnoea, angina and more re-hospitalisations in those with hypertension [66].…”

“…Hypertension associates with increased age, more cardiovascular comorbidities, greater likelihood of persistent AF, and was an independent predictor of increased recurrence of AF post-ablation in earlier studies [63][64][65][66]. A more recent study of 626 patients from 55 centres in the German Ablation Registry showed that AF recurrence rates, freedom from antiarrhythmic medication and repeat ablation were not different with versus without hypertension diagnosis at the time of ablation, though there were more reports of dyspnoea, angina and more re-hospitalisations in those with hypertension [66]. A further multi-centre study of 531 consecutive patients undergoing AF ablation showed again that hypertension itself was not associated with a higher recurrence rate of AF following AF ablation, but poor control of hypertension despite medical therapy pre-procedure did lead to higher recurrence [65].…”

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

“… 412 In contrast, a registry analysis showed that patients with a diagnosis of hypertension, without information regarding the efficiency of antihypertensive management, had similar rhythm outcome after catheter ablation to those without hypertension. 438 In the SMAC-AF randomized trial, short-term aggressive blood pressure (BP) treatment (target systolic BP ≤120 mmHg) for a median duration of 3.5 months before scheduled AF catheter ablation in patients with hypertension did not reduce arrhythmia recurrence following ablation when compared with standard BP treatment (target systolic BP <140 mmHg). 439 Although treating modest hypertension in isolation has not proven to be of benefit, when undertaken in the setting of a comprehensive risk factor management programme in overweight and obese individuals, it has been associated with higher rate of SR maintenance after catheter ablation.…”