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Controlled hypertension may not worsen post-ablation outcomes
In a new study, uncontrolled hypertension conferred an increased risk for recurrence of atrial fibrillation and required more extensive ablation, whereas controlled hypertension appeared to have no effect on outcomes after ablation compared with no hypertension.
Researchers conducted a prospective study of 531 consecutive patients who were undergoing catheter ablation for AF. The patient population was divided into three groups: those with uncontrolled hypertension despite medical treatment with three or more hypertensive therapies (n = 160); those with controlled hypertension as a result of medical treatment (n = 192); and those without hypertension (n = 179).
All patients underwent pulmonary vein antrum isolation and posterior wall isolation. Researchers used a circular mapping catheter (Lasso, Biosense Webster/Johnson & Johnson) and a 3.5-mm irrigated tip catheter (ThermoCool, Biosense Webster) for ablation of the antrum of the pulmonary veins and for achievement of abolition of all electrograms, according to the study. During sinus rhythm, patients received up to 30 mg/m isoproterenol for 15 to 20 hours to establish pulmonary vein reconnection and to identify firing sites not in the pulmonary vein antrum. Follow-up occurred at 3, 6, 9, 12, 18 and 24 months after ablation.
The three groups had different left atrial size, nonpulmonary vein triggers and moderate or severe left atrial scar. Nonpulmonary vein triggers were identified in 58.8% of patients with uncontrolled hypertension, 33.3% of patients with controlled hypertension and 27.9% of patients without hypertension (P < .001).
At a median follow-up of 19 months, the rate of AF recurrence was 40.6% among patients with uncontrolled hypertension, 28.1% among patients with controlled hypertension and 25.7% among patients without hypertension (P = .003).
Among patients with uncontrolled hypertension who underwent additional nonpulmonary vein trigger ablation, the rate of freedom from AF or atrial tachycardia was 69.8%, which was comparable to the other groups in terms of successful outcomes (log rank, P = .7), according to the researchers.
When the researchers adjusted for confounding factors, they found an association between arrhythmia recurrence and uncontrolled hypertension (HR = 1.52; P = .045), nonpulmonary vein triggers (HR = 1.85; P < .001) and nonparoxysmal AF (HR = 1.64; P = .002).
“This is the first study to evaluate the role of uncontrolled hypertension in the context of AF ablation, its clinical and [electrophysiological] features, and the possible ablation strategy. Our results did not show any statistical difference in AF recurrence rate following ablation between patients with controlled hypertension and no hypertension, at the long-term follow-up. By contrast, pharmacologically uncontrolled hypertension confers higher AF recurrence risk and requires more extensive ablation. More nonpulmonary vein triggers were identified in these patients, resulting in higher recurrence if ignored,” the researchers wrote. – by Jennifer Byrne
Disclosure: Several researchers report consulting for and/or receiving speaker honoraria from Biosense Webster. Please see the full study for a list of all of the authors’ relevant financial disclosures.