The association between alcohol consumption, cardiac biomarkers, left atrial size and re-ablation in patients with atrial fibrillation referred for catheter ablation

Abstract

Background Information on alcohol consumption in patients undergoing radiofrequency ablation (RFA) of atrial fibrillation (AF) is often limited by the reliance on self-reports. The aim of this study was to describe the long-term alcohol consumption, measured as ethyl glucuronide in hair (hEtG), in patients undergoing RFA due to AF, and to examine potential associations with cardiac biomarkers, left atrial size and re-ablation within one year after the initial RFA. Methods The amount of hEtG was measured in patients referred for RFA, and a cut-off of 7 pg/mg was used. N-terminal pro B-type natriuretic peptide (NT-proBNP) and the mid-regional fragment of pro atrial natriuretic peptide (MR-proANP) were examined and maximum left atrium volume index (LAVI) was measured. The number of re-ablations was examined up to one year after the initial RFA. Analyses were stratified by gender, and adjusted for age, systolic blood pressure, body mass index, presence of heart failure and heart rhythm for analyses regarding NT-proBNP, MR-proANP and LAVI and heart rhythm being replaced by type of AF for analyses regarding re-ablation. Results In total, 192 patients were included in the study. Median (25th– 75 th percentile) NT-proBNP in men with hEtG ≥ 7 vs. < 7 pg/mg was 250 (96–695) vs. 130 (49–346) pg/ml (p = 0.010), and in women it was 230 (125–480) vs. 230 (125–910) pg/ml (p = 0.810). Median MR-proANP in men with hEtG ≥ 7 vs. < 7 pg/mg was 142 (100–224) vs. 117 (83–179) pmol/l (p = 0.120) and in women it was 139 (112–206) vs. 153 (93–249) pmol/l (p = 0.965). The median of maximum LAVI was 30.1 (26.7–33.9) vs. 25.8 (21.4–32.0) ml/m 2 (p = 0.017) in men, and 25.0 (18.9–29.6) vs. 25.7 (21.7–34.6) ml/m 2 (p = 0.438) in women, with hEtG ≥ 7 vs. < 7 pg/ml, respectively. Adjusted analyses showed similar results, except for MR-proANP turning out significant in men with hEtG ≥ 7 vs. < 7 pg/mg (p = 0.047). The odds ratio of having a re-ablation was 3.5 (95% CI 1.3–9.6, p = 0.017) in men with hEtG ≥ 7 vs. < 7 pg/mg, while there was no significant difference in women. Conclusions In male patients with AF and hEtG ≥ 7 pg/mg, NT-proBNP and MR-proANP were higher, LA volumes larger, and there was a higher rate of re-ablations, as compared to men with hEtG < 7 pg/mg. This implies that men with an alcohol consumption corresponding to an hEtG-value ≥ 7, have a higher risk for LA remodelling that could potentially lead to a deterioration of the AF situation.

Symptoms and health‐related quality of life 5 years after catheter ablation of atrial fibrillation

“…Our data is in line with previous studies that demonstrate that female gender and obesity predict arrhythmia-related symptoms in patients with AF treated with CA. [23][24][25][26] As discussed previously, women usually have a higher symptom burden than men and often experience a more negatively influenced HRQoL. 3,17,27 However, we did not find any gender differences regarding HRQoL at follow-up.…”

“…It is known that IHD in combination with AF worsens the prognosis and has been described as "double trouble." [23][24][25]32 5.4 | Take-home messages/clinical significance in the present study Large-scale clinical follow-up is a challenge since rhythm, symptoms, and HRQoL ideally should all be evaluated long term. The follow-up was carried out 5 years after the procedure, irrespective of whether the patient was waiting for a new evaluation or even waiting for a repeat procedure.…”

“…23,28,29 Obesity is known to be a significant predictor for reduced success rate after CA and has a negative impact on HRQoL, physical health status, and symptom burden during AF episodes. [23][24][25][26]30,31 The importance of self-management strategies with lifestyle interventions is pointed out in the guidelines and is important to consider before referral for CA. 5,29 There is solid evidence regarding the positive effects of lifestyle management, which can lead to a reduced symptom burden, absence of AF, and positive effects on comorbidities.…”

Confounders in Identification and Analysis of Inflammatory Biomarkers in Cardiovascular Diseases

“…In contrast to previous studies that rely on self-reported alcohol consumption, there is another study investigating the relationship between alcohol intake and cardiac biomarkers in men. The study suggests that men with alcohol consumption have a higher concentration of biomarkers that result in a higher risk for cardiac remodeling, leading to atrial fibrillations [74].…”

Echocardiographic and Biochemical Factors Predicting Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation—An Observational Study

“…In the context of the SMURF-study, it was also found that factors such as LA volume, gender, the frequency of attacks prior to RFA and recurrences of AF after RFA significantly affected the improvement in symptoms and HRQoL in patients with AF after RFA (Barmano et al, 2019a). Finally, in male patients with AF, alcohol consumption was associated with higher levels of natriuretic peptides, and the need for re-ablation (Barmano et al, 2019b).…”