Li Rui-Bin, Yang Xiao-Hong, Zhang Ji-Dong, Wang Dong, Cui Xiao-Ran, Bai Long, Zhao Lei, Cui Wei
Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Front Cardiovasc Med. 2022 Jun 3;9:902411. doi: 10.3389/fcvm.2022.902411. eCollection 2022.
The aim of this study was to evaluate the association between subclinical thyroid dysfunction and the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).
We examined the association between subclinical thyroid dysfunction and the recurrence of AF at a large university-affiliated cardiac arrhythmia center in China. Data were collected from consecutive patients who underwent RFCA for AF, excluding those with a history of hypothyroidism, hyperthyroidism, or ongoing medical treatment for hypothyroidism or hyperthyroidism, biochemically defined overt thyroid disease, and long-term use of amiodarone before admission. The primary end point was the recurrence of AF in a time-to-event analysis. We compared outcomes in patients who had subclinical hyperthyroidism or hypothyroidism with those who had euthyroid state, using a multivariable Cox model with inverse probability weighting and propensity score matching.
In all, 93 patients were excluded from 435 consecutive patients who underwent RFCA for AF. Of the remaining 342 patients for the analysis, the prevalence of subclinical hyperthyroidism and subclinical hypothyroidism were 26 (7.6%) and 41 (12.0%), respectively; during a median follow-up of 489 days, 91 patients (26.6%) developed a primary end point event. In the main analysis of the multivariable Cox model, only subclinical hyperthyroidism [hazard ratio: 3.07, 95% confidence interval (CI): 1.54-6.14] was associated with an increased risk of end point event after adjusting for potential confounders. However, the association between subclinical hypothyroidism and the end point event was not significant (hazard ratio: 0.66, 95% CI: 0.31-1.43). Results were consistent either in multiple sensitivity analyses or across all subgroups of analysis. Compared with individuals with free triiodothyronine (fT3) in the lowest quintile, those with fT3 in the highest quintile had an HR of 2.23 (95% CI: 1.16-4.28) for recurrence of AF. With the increase of thyroid-stimulating hormone (TSH), a reduction in the risk of recurrence of AF was detected in the adjusted model, and the hazard ratio (HR) per standard deviation (SD) increase was 0.82 (95% CI: 0.68-0.98).
In this retrospective cohort study involving patients who underwent RFCA for AF, patients with subclinical hyperthyroidism were associated with a markedly higher prevalence of recurrence of AF, whereas patients with subclinical hypothyroidism had a similar recurrence rate of AF compared to those with the euthyroid state.
本研究旨在评估亚临床甲状腺功能障碍与射频导管消融术（RFCA）后房颤（AF）复发之间的关联。
我们在中国一家大型大学附属医院的心律失常中心研究了亚临床甲状腺功能障碍与房颤复发之间的关联。数据收集自连续接受AF射频消融术的患者，排除有甲状腺功能减退、甲状腺功能亢进病史，或正在接受甲状腺功能减退或亢进治疗、生化指标定义的显性甲状腺疾病，以及入院前长期使用胺碘酮的患者。主要终点是生存分析中的房颤复发情况。我们使用具有逆概率加权和倾向评分匹配的多变量Cox模型，比较了亚临床甲状腺功能亢进或减退患者与甲状腺功能正常患者的结局。
在连续接受AF射频消融术的435例患者中，共有93例被排除。在其余342例用于分析的患者中，亚临床甲状腺功能亢进和亚临床甲状腺功能减退的患病率分别为26例（7.6%）和41例（12.0%）；在中位随访489天期间，91例患者（26.6%）发生了主要终点事件。在多变量Cox模型的主要分析中，在调整潜在混杂因素后，仅亚临床甲状腺功能亢进[风险比：3.07，95%置信区间（CI）：1.54 - 6.14]与终点事件风险增加相关。然而，亚临床甲状腺功能减退与终点事件之间的关联不显著（风险比：0.66，95% CI：0.31 - 1.43）。在多次敏感性分析或所有分析亚组中结果均一致。与游离三碘甲状腺原氨酸（fT3）处于最低五分位数的个体相比，fT3处于最高五分位数的个体房颤复发的风险比为2.23（95% CI：1.16 - 4.28）。随着促甲状腺激素（TSH）升高，在调整模型中检测到房颤复发风险降低，每增加一个标准差（SD）的风险比（HR）为0.82（95% CI：0.68 - 0.98）。
在这项涉及接受AF射频消融术患者的回顾性队列研究中，亚临床甲状腺功能亢进患者房颤复发的患病率明显更高，而亚临床甲状腺功能减退患者与甲状腺功能正常患者的房颤复发率相似。
