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 Fassini; Michela Casella; Antonio Dello Russo; Claudio Tondo; Andrea Natale

doi:10.1016/j.jacep.2015.04.002

Impact of Uncontrolled Hypertension on Atrial Fibrillation Ablation Outcome

JACC Clin Electrophysiol. 2015 Jun;1(3):164-173. doi: 10.1016/j.jacep.2015.04.002. Epub 2015 Apr 20.

Authors

Francesco Santoro¹, Luigi Di Biase², Chintan Trivedi³, John David Burkhardt³, Alessandro Paoletti Perini⁴, Javier Sanchez³, Rodney Horton³, Prasant Mohanty³, Sanghamitra Mohanty³, Rong Bai³, Pasquale Santangeli⁵, Dhanunjay Lakkireddy⁶, Madhu Reddy⁶, Claude Samy Elayi⁷, Richard Hongo⁸, Salwa Beheiry⁸, Steven Hao⁹, Robert A Schweikert⁹, Juan Viles-Gonzalez¹⁰, Gaetano Fassini¹¹, Michela Casella¹¹, Antonio Dello Russo¹¹, Claudio Tondo¹¹, Andrea Natale¹²

Affiliations

¹ Department of Cardiology, University of Foggia, Foggia, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
² Department of Cardiology, University of Foggia, Foggia, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Electrophysiology Section, Montefiore Hospital, Albert Einstein College of Medicine, New York, New York.
³ Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
⁴ Heart and Vessel Department, University of Florence, Florence, Italy.
⁵ Department of Cardiology, University of Foggia, Foggia, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Cardiovascular Division, Electrophysiology Section, University of Pennsylvania, Philadelphia, Pennsylvania.
⁶ Cardiovascular Division, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
⁷ Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
⁸ Electrophysiology Section, California Pacific Medical Center, San Francisco, California.
⁹ Electrophysiology Section, Akron General Hospital, Akron, Ohio.
¹⁰ Electrophysiology Section, University of Miami, Miller School Of Medicine, Miami, Florida.
¹¹ Department of Arrhythmology, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
¹² Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Electrophysiology Section, California Pacific Medical Center, San Francisco, California; Division of Cardiology, Stanford University, Palo Alto, California; Interventional Electrophysiology Section, Scripps Clinic, San Diego, California. Electronic address: dr.natale@gmail.com.

PMID: 29759360
DOI: 10.1016/j.jacep.2015.04.002

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.

Keywords: atrial fibrillation; catheter ablation; hypertension; non-PV triggers; pulmonary vein isolation; uncontrolled hypertension.