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Updated: May 6, 2026
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Pre-procedural Stratification by the Endothelial Function in Patients with Heart Failure Undergoing Atrial
Akihiro Oka1, Yuya Sudo1, Takeshi Morimoto2
1Department of Cardiovascular Medicine, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu, Kagawa, 760-8557, Japan.
Insights
Endothelial dysfunction (ED) predicts worse outcomes after atrial fibrillation (AF) ablation in heart failure (HF) patients. Assessing ED before ablation helps stratify risks for persistent AF recurrence and cardiovascular events.
Area of Science:
- Cardiology
- Vascular Biology
- Electrophysiology
Background:
- Endothelial dysfunction (ED) is a cardiovascular risk marker linked to heart failure (HF) and atrial fibrillation (AF).
- The prognostic value of ED for outcomes after AF ablation in HF patients is not well understood.
Purpose of the Study:
- To investigate the association between pre-procedural endothelial function and clinical outcomes following AF ablation in patients with HF.
Main Methods:
- Prospective cohort study of 421 HF patients undergoing AF ablation.
- Endothelial function assessed via peripheral vascular reactive hyperemia index (RHI); ED defined as RHI < 2.1.
- Outcomes analyzed included AF recurrence (conventional and persistent forms) and cardiovascular events over 3 years.
Main Results:
- 81.5% of patients had ED. The ED group showed a significantly higher incidence of persistent AF recurrence (25.7% vs. 15.3%) and cardiovascular events (14.8% vs. 3.6%) compared to those without ED.
- Pre-procedural ED independently predicted persistent AF recurrence (aHR 2.31) and cardiovascular events (aHR 4.21).
Conclusions:
- Pre-procedural endothelial function assessment is valuable for risk stratification in HF patients undergoing AF ablation.
- Identifying ED can help predict adverse outcomes like persistent AF recurrence and cardiovascular events.
Background:
Endothelial dysfunction (ED), a well-established risk marker of cardiovascular events, is associated with heart failure (HF) and atrial fibrillation (AF). Its relationship with cardiovascular events in patients with HF undergoing AF ablation remains unclear. We aimed to elucidate the association between ED and the outcomes after AF ablation in patients with HF.
Methods:
This prospective cohort study included patients with HF who underwent an endothelial function assessment using the peripheral vascular reactive hyperemia index (RHI) before first-time AF ablation. We defined AF recurrence according to the following types: the conventional form (AF≥30 seconds) and persistent form (requiring cardioversion). An RHI<2.1 indicated ED. Those with and without ED were compared in terms of the 3-year incidence of AF recurrence and cardiovascular events after AF ablation.
Results:
Among 421 patients with HF (69 ± 9 years and 38% females), 343 (81.5%) had ED. Although the incidence of the conventional form of AF recurrence was similar between the groups, that of the persistent form was significantly higher in the ED group (25.7% vs. 15.3%, log-rank P = 0.028). The ED group also had a significantly higher rate of cardiovascular events (14.8% vs. 3.6%, log-rank P = 0.028). Pre-procedural ED was identified as an independent predictor of a persistent form of AF recurrence (adjusted hazard ratio [HR] 2.31, 95% confidence interval [CI] 1.05-5.07, P = 0.037) and that of cardiovascular events (adjusted HR 4.21, 95% CI 1.02-17.5, P = 0.048), respectively.
Conclusions:
The endothelial function assessment enabled the risk stratification of clinically problematic outcomes after AF ablation in patients with HF.
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