Espersen Caroline, Modin Daniel, Johansen Niklas Dyrby, Janstrup Kira Hyldekær, Johannessen Arne, Hansen Jim, Eskesen Kristian, Iversen Allan Zeeberg, Worck René H, Ruwald Martin H, Hansen Morten Lock, Gislason Gunnar H, San José Estépar Raúl, Marcus Gregory M, Biering-Sørensen Tor
Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Heart Rhythm. 2025 Mar;22(3):668-674. doi: 10.1016/j.hrthm.2024.08.022. Epub 2024 Aug 13.
Ischemic heart disease (IHD) has been linked to an increased risk of atrial fibrillation (AF). However, data are sparse regarding the role of IHD in AF recurrence after catheter ablation.
We sought to investigate whether preexisting or new-onset IHD is associated with a greater risk of AF recurrence after ablation.
With use of Danish nationwide registries, all patients undergoing first-time AF ablation in Denmark from 2010 to 2020 were identified. The primary outcome was AF recurrence defined by AF-related hospital admission or antiarrhythmic drug use within 1 year after ablation excluding a 3-month blanking period. IHD was defined as an International Classification of Diseases, Tenth Revision diagnosis of IHD or prior coronary revascularization.
Of 12,162 patients undergoing first-time ablation for AF (mean age, 62 years; 30% female), 20% had preexisting IHD. Preexisting IHD was associated with an increased risk of AF recurrence in univariable log-binomial logistic regression (relative risk, 1.09; 95% CI, 1.04-1.14; P < .001). However, after multivariable adjustment including procedural year, preexisting IHD was no longer associated with an increased risk of AF recurrence (relative risk, 1.02; 95% CI, 0.97-1.06; P = .42). In a nested case-control study of those without preexisting IHD before ablation (n = 9778), newly diagnosed IHD after ablation was associated with an increased risk of AF recurrence in multivariable analysis (hazard ratio, 3.03; 95% CI, 1.84-4.99; P < .001).
The presence of IHD does not appear to reduce the effectiveness of AF ablation procedures. However, the emergence of IHD after AF ablation may serve as a trigger for AF that is insufficiently suppressed by prior ablation.
缺血性心脏病（IHD）与心房颤动（AF）风险增加有关。然而，关于IHD在导管消融术后房颤复发中的作用的数据很少。
我们试图研究既往存在的或新发的IHD是否与消融术后房颤复发风险增加有关。
利用丹麦全国登记系统，确定了2010年至2020年在丹麦接受首次房颤消融的所有患者。主要结局是房颤复发，定义为消融术后1年内（不包括3个月的空白期）因房颤相关住院或使用抗心律失常药物。IHD定义为国际疾病分类第十版诊断的IHD或既往冠状动脉血运重建。
在12162例接受首次房颤消融的患者中（平均年龄62岁；30%为女性），20%有既往IHD。在单变量对数二项逻辑回归中，既往IHD与房颤复发风险增加相关（相对风险，1.09；95%CI，1.04-1.14；P<.001）。然而，在包括手术年份在内的多变量调整后，既往IHD不再与房颤复发风险增加相关（相对风险，1.02；95%CI，0.97-1.06；P = 0.42）。在一项对消融术前无既往IHD的患者（n = 9778）进行的巢式病例对照研究中，消融后新诊断的IHD在多变量分析中与房颤复发风险增加相关（风险比，3.03；95%CI，1.84-4.99；P<.001）。
IHD的存在似乎不会降低房颤消融手术的有效性。然而，房颤消融术后IHD的出现可能是房颤的一个触发因素，而先前的消融未能充分抑制房颤。
