Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation: the potential role of inflammation

Abstract

Conventional markers of the inflammatory cascade such as WBC count and high-sensitivity C-reactive protein as well as elements of the metabolic syndrome such as hypertension and increased BMI were significantly associated with AF recurrence. The impact of a pre-ablative inflammatory state in the overall success rate of PVI needs further elucidation.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…268,282,283,284,285,286,287,288,289,290,291,292,293,294,295,296,297,298 A recent meta-analysis identified 16 studies involving 5864 individuals reporting on the link between obesity and recurrence of AF after catheter ablation, identifying that there was a 3.1% greater risk of recurrent AF postablation for every one unit increase in BMI (RR 1.03; 95% CI 1.00–1.07). 299 …”

2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design

“…Second, it is possible that late recurrences of AF are a result of post-ablation modulation in autonomic innervations of the heart and PVs [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77]. And finally, it is possible that ongoing electrical and structural remodeling of the atria as a result of aging, heart failure, inflammation, and other comorbidities such as diabetes [129][130][131][132][133][134][135][136] leads to progressive atrial electrical instability. Evidence to support the latter hypothesis is derived in part by the studies reporting that patients with comorbid conditions such as sleep apnea, HTN, and hypercholesterolemia, as well as those with a history of persistent AF, are at highest risk of late recurrence [135,[137][138][139].…”

Comparison of CHADS 2 , R 2 CHADS 2 , and CHA 2 DS 2 -VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation

“…Although acute inflammatory responses after invasive treatment would explain ERAF, 23 the components of thromboembolic scores indicate the association with LRAF. Of note, some components of stroke stratification scores are also presented in metabolic syndrome, which is associated with AF recurrences after catheter ablation.…”