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Clinical Relationship Between Anemia and Atrial Fibrillation Recurrence After Catheter Ablation Without Genetic Background

 Min Kim  ;  Myunghee Hong  ;  Jong-Youn Kim  ;  In-Soo Kim  ;  Hee Tae Yu  ;  Tae-Hoon Kim  ;  Jae-Sun Uhm  ;  Boyoung Joung  ;  Moon-Hyoung Lee  ;  Hui-Nam Pak 
 International Journal of Cardiology. Heart & Vasculature, Vol.27 : 100507, 2020-04 
Journal Title
International Journal of Cardiology. Heart & Vasculature
Issue Date
Anemia ; Atrial fibrillation ; Catheter ablation ; Mendelian randomization
Background: Anemia is a known adverse prognostic factor among patients with cardiovascular diseases. We investigated whether the hemoglobin level was associated with the rhythm outcome after atrial fibrillation (AF) catheter ablation (AFCA).

Methods: We included 2627 patients who underwent AFCA and a guidelines-based rhythm follow-up (age 58 ± 10.9 years, 73% men, 30.6% with persistent AF), and evaluated the association of pre-AFCA anemia (haemoglobin <13 g/dL in men and <12 g/dL in women) and rhythm outcomes. We studied the mechanistic relationship between anemia and AF recurrence using a Mendelian randomization analysis (1775 subjects with genome-wide association study) after reviewing already proven 12 hemoglobin-associated genetic polymorphisms.

Results: The body mass index, paroxysmal AF, warfarin use, and baseline red cell distribution width were independently associated with anemia in patients with AF. During a 23-month follow-up (interval OR 9-48 months), the clinical AF recurrence rate was significantly higher in patients with than without anemia (log-rank p = 0.001; propensity score-matched log-rank p = 0.004). This pattern was more significant in male patients (Log-rank p < 0.001) or patients with paroxysmal AF (Log-rank p < 0.001). Anemia (hazard ratio [HR] 1.45 [1.17-1.80], p = 0.001), left atrial diameter (HR 1.03 [1.01-1.04], p < 0.001), a female sex (HR 1.17 [1.00-1.36], p = 0.047), and persistent AF (HR 1.58 [1.36-1.84], p < 0.001) were independently associated with post-AFCA clinical recurrence. In the Mendelian randomization, we could not find a significant direct causal relationship between anemia and AF recurrence at the genetic level.

Conclusions: Pre-AFCA anemia is an independent predictor of post-AFCA clinical recurrence, especially in male patients, without a genetically direct causal relationship.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min(김민) ORCID logo https://orcid.org/0000-0002-8132-9873
Kim, In-Soo(김인수) ORCID logo https://orcid.org/0000-0003-2801-5514
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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