Atrial Fibrillation: More Than an Electrical Problem
A small study highlights a big point: manage risk factors that affect the atrial fibrillation substrate and ablation therapy success rates improve (ARREST-AF Cohort Study).
We often divide up the different types of cardiac diseases into three distinct systems: (1) the “plumbing” (coronary artery disease [CAD]); (2) the “electricity”; and (3) the “pump”. However, we are now are beginning to appreciate that the risk factors for these systems and diseases are much more closely interrelated than was previously appreciated. Atrial fibrillation (AF), which was traditionally placed into the “electricity” category, has now shown a clear relationship to risk factors for “plumbing” diseases, such as hypertension, hyperlipidemia, diabetes and obesity.
In a small study entitled ARREST-AF Cohort study from a group in Australia, Dr Pathak and colleagues demonstrated the importance of managing underlying CAD risk factors, which can affect atrial remodeling and function, in preventing the recurrence of AF after catheter ablation.
The prevalence of AF is expected to be 15.9 million (from 2.7 million currently) in the US by the year 2050. “Traditional” cardiovascular risk factors, such as hypertension, obesity, sleep apnea, and diabetes, have been linked to the occurrence of AF.Although catheter ablation is emerging as an effective therapy, there is often late recurrence after a successful ablation. In this study, the authors wanted to answer the question of whether late recurrence of AF was due, in part, to underlying cardiovascular risk factors and whether aggressive risk factor modification would decrease failure rate of catheter ablation.
Inclusion Criteria: BMIâ¥27 kg/m2 and â¥1 risk factor (hypertension, glucose intolerance or diabetes, hyperlipidemia, obstructive sleep apnea, smoking); undergoing catheter ablation for symptomatic AF despite antiarrhythmic medication; those with CAD or previous ablation were excluded; follow-up: every 3 months up to 2 years with symptoms, ECGs and ambulatory 7-day monitoring.
Those with CAD or previous ablation were excluded. Follow-up: every 3 months up to 2 years with symptoms, ECGs and ambulatory 7-day monitoring. Patients were offered risk factor management and assigned based on whether he or she was agreeable to receiving this therapy.
Intervention Group (n=61): risk factor management in physician clinic every 3 months: BP control with target BP 130 mg/dL; glycemic control (HbA1c goal â¤6.5%); sleep apnea management; smoking and alcohol cessation counseling.
Results of ARREST-AF: Those in the intervention arm had a higher AF-free survival after a single or multiple ablations compared with those in the standard of care arm. Single ablation: 62% vs 26%, P
We often divide up the different types of cardiac disease into 3 distinct systems: (1) the “plumbing” (coronary artery disease [CAD]); (2) the “electricity”; and (3) the “pump.” However, we are now are beginning to appreciate that the risk factors that affect these systems and underlie heart disease are more closely interrelated than was previously thought. Atrial fibrillation (AF), which was traditionally placed into the “electricity” category, has now shown a clear relationship to risk factors for “plumbing” diseases, such as hypertension, hyperlipidemia, diabetes, and obesity. Results of the Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation: The ARREST-AF Cohort Study from Australia, published in the Journal of the American College of Cardiology in December 2014, demonstrate the potential for more successful outcomes when we can "blur the lines" among traditional categories.Â
