Prevalence and Impact of Poorly Controlled Modifiable Risk Factors among Patients Undergoing Atrial Fibrillation Ablation

Abstract Purpose: Managing atrial fibrillation (AF) risk factors (RF) improves ablation outcomes in obese patients. However, real-world data including non-obese patients is limited. Methods: Pre-specified modifiable RFs among 724 consecutive patients undergoing AF ablation at a tertiary care hospital from 2012 to 2019 were examined. These included body mass index (BMI) ≥ 30 kg/m2, > 5% fluctuation in BMI, obstructive sleep apnea with continuous positive airway pressure non-compliance, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hyperlipidemia, tobacco use, alcohol use above the standard recommendation, and a diagnosis-to-ablation time (DAT) > 1.5 years. The primary outcome was a composite of arrhythmia recurrence, cardiovascular admissions, and cardiovascular death. Results: We identified a high prevalence of pre-ablation modifiable RFs with more than 50% of the study patients experiencing uncontrolled HLD, BMI ≥ 30 mg/m2, fluctuating BMI > 5% or experiencing delayed DAT. During a median follow-up of 2.6 (interquartile range 1.4, 4.6) years, 467 (64.5%) patients met the primary outcome. Independent RFs were a fluctuation in BMI > 5% (hazard ratio [HR] 1.31; P = 0.008), diabetes with A1c ≥ 6.5% (HR 1.50; P = 0.014) and uncontrolled hyperlipidemia (HR 1.30; P = 0.005). A total of 264 (36.46%) patients had at least two of these predictive RFs, which was associated with higher incidence of the primary outcome. Delayed DAT over 1.5 years did not alter the ablation outcome. Conclusions: Substantial portions of patients undergoing AF ablation have potentially modifiable RFs that were not well controlled. Fluctuating BMI, diabetes with HbA1c ≥ 6.5%, and uncontrolled HLD portend an increased risk of recurrent arrhythmia, CV hospitalizations and mortality following ablation.