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Verhaert DVM, Knackstedt C, Lankveld TAR, Den Uijl DW, Habibi Z, Westra SW, Hermans ANL, Betz K, Van Der Velden RMJ, Gawalko MM, Schotten U, Linz DK, Vernooy K. We all know A and B, but what about C? Exploring the management of modifiable risk factors in patients with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF) advise to treat AF according to the ABC pathway: A, anticoagulation, B, better symptom control, and C, comorbidities and cardiovascular risk factor management. Optimal treatment of comorbidities and risk factors slows AF progression and improves success rates of rhythm interventions for AF. However, several studies report underdiagnosis and therefore possible undertreatment for common cardiovascular comorbidities.
Purpose
This study aims to evaluate how common modifiable cardiovascular risk factors are managed in AF patients referred for catheter ablation.
Methods
This is a substudy of the ISOLATION study, a prospective cohort study including consecutive patients with paroxysmal or persistent AF referred for AF ablation. Screening for common modifiable risk factors for AF is structurally embedded in the work-up for AF ablation in the two participating centres. In the present study the prevalence of the following risk factors at this screening moment was assessed: (1) body mass index (BMI) above the target BMI for ablation (≥27 kg/m2), (2) hypertension, defined as on-site systolic blood pressure >130 mmHg and/or diastolic blood pressure >80 mmHg, (3) decreased glucose tolerance or diabetes mellitus, defined as HbA1c ≥6.5%, (4) dyslipidaemia, defined as low-density lipoprotein (LDL) ≥2.5 mmol/l, (5) regular alcohol consumption, defined as self-reported consumption of >15 standardized units/week, and (6) sleep disordered breathing (SDB), defined as apnoea-hypopnoea index (AHI) ≥15 assessed with home sleep tests (subset of patients).
Results
Among the 981 patients studied (median age 65 [59–71] years old, 64% male, 69% paroxysmal AF), previously diagnosed comorbidities were common (46% hypertension, 7% diabetes, 22% dyslipidaemia, 10% SDB), and a large proportion of patients received targeted treatment (Table 1). However, non-optimally managed risk factors remained significant (Figure 1). BMI ≥27 kg/m2 was present in 56% of patients. High systolic and diastolic blood pressure were present in 62% and 51% of patients, respectively, and any form of high blood pressure (either systolic or diastolic) was seen in 72% of patients. HbA1c was found to be above target ranges in 9% patients and LDL in 56%. A weekly alcohol consumption of ≥15 units was reported by 4% of patients. Screening for SDB was performed in a subset of patients (n=287), for whom AHI was ≥15 in 52%. Overall, 9% of patients had 4 or more non-optimally controlled modifiable risk factors, whereas the median number of modifiable risk factors was 2 [1–3].
Conclusions
Structural screening revealed a high prevalence of non-optimally controlled modifiable cardiovascular risk factors in patients referred for AF catheter ablation. According to recent ESC guidelines, improving treatment of comorbidities may improve AF ablation success rates and even reduce mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D V M Verhaert
- Maastricht University Medical Center and Radboud University Medical Center, Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht/Nijmegen , The Netherlands
| | - C Knackstedt
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - T A R Lankveld
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - D W Den Uijl
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - Z Habibi
- Maastricht University Medical Center and Radboud University Medical Center, Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht/Nijmegen , The Netherlands
| | - S W Westra
- Radboud University Medical Center , Nijmegen , The Netherlands
| | - A N L Hermans
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - K Betz
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - R M J Van Der Velden
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - M M Gawalko
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - U Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Department of physiology , Maastricht , The Netherlands
| | - D K Linz
- Maastricht University Medical Center and Radboud University Medical Center, Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht/Nijmegen , The Netherlands
| | - K Vernooy
- Maastricht University Medical Center and Radboud University Medical Center, Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM) , Maastricht/Nijmegen , The Netherlands
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Marti Almor J, Bazan V, Matiello M, Cian D, Oliva X, Altaba C, Guijo MA, Bruguera J, Fiala M, Sknouril M, Dorda M, Chovancik J, Nevralova R, Jiravsky O, Jiravska-Godula B, Branny M, Elvan A, Beukema WP, Smit JJJ, Delnoy PPHM, Ramdat Misier AR, Tuan J, Chung I, Jeilan M, Kundu S, Osman F, Stafford P, Ng GA, Vergara P, Mazzone P, Paglino G, Saviano M, Crisa S, Maida G, Vicedomini G, Pappone C, Miyazaki S, Wright M, Hocini M, Jais P, Haissaguerre M, Yoshitani K, Kaitani K, Hanazawa K, Nakagawa Y, Yokokawa M, Tada H, Naito S, Oshima S, Taniguchi K, Romanov A, Pokushalov E, Shugaev P, Artemenko S, Turov A, Gindele FM, Wiedemann M, Ewertsen C, Heiderfazel S, Andresen D, Kaitani K, Hanazawa K, Yoshitani K, Miyake M, Motooka M, Izumi T, Izumi C, Nakagawa Y, Sunthorn H, Burri HB, Gentil PG, Shah DS, Sugiura S, Fujii E, Senga M, Yamazato S, Nakamura M, Ito M, Den Uijl DW, Delgado V, Tops LF, Trines SAIP, Zeppenfeld K, Van Der Wall EE, Schalij MJ, Bax JJ, Pappalardo A, Forleo GB, Avella A, Bencardino G, De Girolamo PG, Dello Russo A, Laurenzi F, Tondo C, Mueller H, Burri H, Gentil-Baron P, Lerch R, Shah D, Pokushalov E, Romanov A, Turov A, Shugaev P, Artemenko S, Shirokova N, Pedrote Martinez AA, Arana E, Garcia-Riesco L, Urbano-Moral JA, Frutos-Lopez M, Sanchez-Brotons JA, Torres-Llergo J, Martinez-Martinez A, Matsuda H, Harada T, Nakano E, Takai M, Fujita S, Sasaki T, Mizuno K, Miyake F, Doshi A, Hummel J, Daoud E, Augostini R, Weiss R, Hart D, Houmsse M, Kalbfleisch S, Fiala M, Chovancik J, Gorzolka J, Bulkova V, Wojnarova D, Neuwirth R, Januska J, Branny M, Cerrato E, Amellone C, Tizzani E, Antolini M, Massa R, Golzio PG, Comoglio C, Rinaldi M, El-Domiaty HA, Kamal HM, Moubarak AM, Mansy MM, El-Kerdawy H, Ahmed S, Klinkenberg TJ, Ten Hagen A, Wiesfeld ACP, Tan ES, Van Gelder IC. Poster Session 1: Ablation of atrial fibrillation. Europace 2009. [DOI: 10.1093/europace/euq213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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