Abstract 4367249: Incident Comorbidities May Impact Rhythm Control Strategies and Outcomes After Catheter Ablation of Atrial Fibrillation: The Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (ARRC-AF) Study

Abstract

Background: Rhythm control with catheter ablation (CA) of atrial fibrillation (AF) leads to reverse remodeling of AF substrate. Comorbidities may impact this process and outcomes. Sparse cardiovascular (CV) guidelines address comorbidities and rhythm control practices after CA. We characterized incident comorbidities after index CA that may impact outcomes, reablation, or antiarrhythmic drug (AAD) practices after CA in the ARRC-AF study. Methods: 2,429,863 patients in Optum’s deidentified Market Clarity Data (Market Clarity ® ) newly diagnosed with AF (2007–2021) were followed until disenrollment, death, or study end; 23,323 patients underwent index CA. Comorbidity status before CA and comorbidity event rates after CA were analyzed. We examined these before and during intervening periods between CAs and while receiving medical therapy. Results: Among the 23,323 patients who underwent index CA (median follow-up: 3.2 years; 44.6% prescribed AADs), baseline comorbidities included hypertension (51.8%), coronary artery disease (17.9%), obstructive sleep apnea (14.4%), diabetes (11.7%), heart failure (10.5%), chronic obstructive pulmonary disease (8.9%), peripheral vascular disease (5.4%), valvular heart disease (4.9%), and chronic kidney disease (1.1%). During follow up, 19,461 patients (83.4%) had no further CA; 3,862 patients (46.7% prescribed AADs) had ≥1 reablation (1 reablation, 14.2%; 2 reablations, 2.0%; ≥3 reablations, 0.4%; interval between Cas of 539, 536, and 458 days, respectively). Individual comorbidity event rates after CA ranged from 0 to 4.7% in the 3 cohorts with ≥1 comorbidity/patient ( Table ). Conclusion: After CA, new comorbidities continue to emerge at a modest rate. In general, comorbidity event rates increased as the number of reablations increased. Both CV and non-CV comorbidities need to be assessed before reablation (with and without long-term AAD therapy) for potential impact on endpoints and need best practice management. Co-morbidities can impact outcomes and need to be considered for their impact on sample sizes, study endpoints, morbidity, and mortality in AF ablation trials. Optimizing management of comorbidities could potentially improve results of AF interventions