Prognostic importance of ischemic heart disease for patients with atrial fibrillation undergoing catheter ablation.

Background: 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.
Objective: We sought to investigate whether preexisting or new-onset IHD is associated with a greater risk of AF recurrence after ablation.
Methods: 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.
Results: 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).
Conclusion: 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.
Competing Interests: Disclosures T.B.-S.: steering committee member of the Amgen-financed GALACTIC-HF trial; steering committee member of the Boehringer Ingelheim–financed SHARP3 trial; chief investigator of the Boston Scientific–financed DANLOGIC-HF trial; chief investigator of the Sanofi Pasteur–financed NUDGE-FLU trial; chief investigator of the Sanofi Pasteur–financed DANFLU-1 trial; chief investigator of the Sanofi Pasteur–financed DANFLU-2 trial; steering committee member of LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific's Investigational ICM System trial; advisory board: Sanofi Pasteur, Amgen, CSL Seqirus, and GSK; speaker honorarium: Bayer, Novartis, Sanofi Pasteur, GE Healthcare, and GSK; research grants: Boston Scientific, GE Healthcare, AstraZeneca, Novo Nordisk, and Sanofi Pasteur; consultant appointments: Novo Nordisk, IQVIA, and Parexel. All other authors report that they have no relevant conflicts of interest to disclose.
(Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)