Impact of carotid atherosclerosis on arrhythmia recurrence following atrial fibrillation catheter ablation

• Published in: Pacing and clinical electrophysiology 2023-04, Vol.46 (4), p.332-340
• Main Authors: Luo, Fangyuan, Sun, Liping, Li, Jiaju, Chen, Jiawei, Zhang, Yuekun, Wang, Zhe, Chen, Xiaojie, Chen, Yingwei, Dong, Jianzeng
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Arrhythmia; Arteriosclerosis; Atherosclerosis; Atrial Fibrillation; Cardiac arrhythmia; Carotid Artery Diseases - etiology; Carotid Artery Diseases - surgery; carotid atherosclerosis; Carotid Intima-Media Thickness; carotid plaque; Catheter Ablation - adverse effects; Catheters; EKG; Female; Fibrillation; Humans; Male; Middle Aged; Plaques; Radiofrequency ablation; Recurrence; Regression analysis; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14679

Background It remains unclear whether carotid atherosclerosis (CAS) increases the atrial fibrillation (AF) recurrence rate after ablation. The aim was to assess the association between CAS, defined as carotid intima‐media thickness (CIMT) ≥1 mm and or presence of carotid plaques, and AF recurrence rate after ablation. Methods We retrospectively collected patients who underwent carotid ultrasonography and AF ablation at the First Affiliated Hospital of Zhengzhou University. The AF recurrence was defined as documented atrial arrhythmias over 30 s on ECG or 24‐h Holter monitoring after the first three months blanking period. Cox regression models were used to analyze the risk of AF recurrence. Results Overall, 385 patients were analyzed (mean age, 60.58±10.98 years old; female, 41.30%; persistent AF, 47.27%). After a follow‐up of 1 year, 138 (35.84%) patients experienced recurrence, Kaplan–Meier analysis showed that patients with the presence of carotid plaques, CIMT ≥1 mm, and CAS had a higher risk of recurrence compared with the absence (all log‐rank p < .05). In multivariate Cox regression analysis, CAS (HR 2.159, ±95% CI 1.320‐3.532, p = .002), carotid plaque (HR 1.815, ±95%CI 1.160‐2.841, p = .009), and CIMT ≥1 mm (HR 1.696, ±95%CI 1.192‐2.413, p = .003) were independently associated with a higher risk of recurrence. In subgroup analysis, the association of CAS, carotid plaque, and AF recurrence rate was weaker in men than women. Conclusion Carotid atherosclerosis, CIMT ≥1 mm, and carotid plaque were significantly associated with a higher AF recurrence rate after radiofrequency catheter ablation. They were all risk factors for the recurrence of AF.