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

Abstract

ObjectivesRelationship 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.MethodsThe 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.ResultsAmong 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.ConclusionsThe periodontitis as representative of chronic inflammation was an independent predictor of arrhythmic events and MACE in patients with AF.

Oral Health and Cardiovascular Disorders

“…The same inflammatory markers are involved in both atherosclerosis and periodontitis [21]. Periodontitis impairs endothelial function and is also associated with oxidative stress [13].…”

“…It is known to impair periodontal tissue perfusion, inflammatory reaction, fibroblast function, and tissue healing, causing also endothelial dysfunction [2]. Several cardiovascular disorders were associated with periodontitis, such as stroke, coronary heart disease, peripheral vascular disease, arrhythmias, and aorta aneurysm [11,13,22].…”

“…Periodontitis, as a chronic inflammatory disorder, was an independent predictor of arrhythmic events and major adverse cardiac events in patients with atrial fibrillation (AF) according to a study including 227 patients with AF [13]. The link periodontitis-atrial fibrillation is explained by the inflammatory infiltration of atrial cardiomyocytes causing hypertrophy, oxidative stress, and the cardiac tissue damage induced by antibodies generated in response to Porphyromonas gingivalis and Prevotella intermedia [13,32]. The control of periodontitis may improve inflammation and may prevent embolic events and recurrence of arrhythmia [13].…”

“…The link periodontitis-atrial fibrillation is explained by the inflammatory infiltration of atrial cardiomyocytes causing hypertrophy, oxidative stress, and the cardiac tissue damage induced by antibodies generated in response to Porphyromonas gingivalis and Prevotella intermedia [13,32]. The control of periodontitis may improve inflammation and may prevent embolic events and recurrence of arrhythmia [13]. Chen et al also reported an increased risk of atrial fibrillation or flutter in patients with periodontitis, according to a study including the nationwide database of the Taiwanese population (393,745 patients with periodontitis and 393,745 non-PD individuals) [33].…”

“…However, the association PD-atrial fibrillation or flutter was not significant in patients with hyperthyroidism, a disorder with a significant role in triggering those arrhythmias [33]. Other arrhythmias, such as atrial tachycardia, atrial and ventricular premature contractions, and ventricular tachycardia, were also more common in patients with periodontitis [13]. Periodontitis may influence tachyarrhythmia progression [34].…”