Impact of uncontrolled hypertension on atrial fibrillation ablation outcome

Francesco Santoro, Luigi Di Biase, Chintan Trivedi, John David Burkhardt, Alessandro Paoletti Perini, Javier Sanchez, Rodney Horton, Prasant Mohanty, Sanghamitra Mohanty, Rong Bai, Pasquale Santangeli, Dhanunjay Lakkireddy, Madhu Reddy, Claude Samy Elayi, Richard Hongo, Salwa Beheiry, Steven Hao, Robert A. Schweikert, Juan Viles-Gonzalez, Gaetano FassiniMichela Casella, Antonio Dello Russo, Claudio Tondo, Andrea Natale

Research output: Contribution to journalArticle

Abstract

Objectives The goal of this study was to evaluate the impact of hypertension on the outcome of atrial fibrillation (AF) ablation. Background Hypertension is a well-known independent risk factor for incident AF. Methods A total of 531 consecutive patients undergoing AF ablation were enrolled in this study and divided into 3 groups: patients with uncontrolled hypertension despite medical treatment (group I, n = 160), patients with controlled hypertension (group II, n = 192), and patients without hypertension (group III, n = 179). Pulmonary vein (PV) antrum and posterior wall isolation was always performed, and non-PV triggers were identified during isoproterenol infusion. All patients underwent extensive follow-up. Results Three groups differed in terms of left atrial (LA) size, non-PV triggers, and moderate/severe LA scar. Non-PV triggers were present in 94 (58.8%), 64 (33.3%), and 50 (27.9%) patients in groups I, II, and III, respectively (p <0.001). After 19 ± 7.7 months of follow-up, 65 (40.6%), 54 (28.1%), and 46 (25.7%) patients in groups I, II, and III had recurrences (log-rank test, p = 0.003). Among patients in group I who underwent additional non-PV trigger ablation, freedom from AF/atrial tachycardia was 69.8%, which was similar to groups II and III procedural success (log-rank p = 0.7). After adjusting for confounders, uncontrolled hypertension (group I) (hazard ratio [HR]: 1.52, p = 0.045), non-PV triggers (HR: 1.85, p <0.001), and nonparoxysmal AF (HR: 1.64, p = 0.002) demonstrated significant association with arrhythmia recurrence. Conclusions Controlled hypertension does not affect the AF ablation outcome when compared with patients without hypertension. By contrast, uncontrolled hypertension confers higher AF recurrence risk and requires more extensive ablation.

Original languageEnglish
Pages (from-to)164-173
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume1
Issue number3
DOIs
Publication statusPublished - Jun 1 2015

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Keywords

  • atrial fibrillation
  • catheter ablation
  • hypertension
  • non-PV triggers
  • pulmonary vein isolation
  • uncontrolled hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Santoro, F., Di Biase, L., Trivedi, C., Burkhardt, J. D., Paoletti Perini, A., Sanchez, J., Horton, R., Mohanty, P., Mohanty, S., Bai, R., Santangeli, P., Lakkireddy, D., Reddy, M., Elayi, C. S., Hongo, R., Beheiry, S., Hao, S., Schweikert, R. A., Viles-Gonzalez, J., ... Natale, A. (2015). Impact of uncontrolled hypertension on atrial fibrillation ablation outcome. JACC: Clinical Electrophysiology, 1(3), 164-173. https://doi.org/10.1016/j.jacep.2015.04.002