| Part One The Association between Subclinical Thyroid Dysfunction and Recurrence of Atrial Fibrillation after Catheter AblationObjective: To evaluate the association between subclinical thyroid dysfunction and recurrence of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods: We examined the association between subclinical thyroid dysfunction and recurrence of AF at a large university affiliated cardiac arrhythmia center in China.Data were obtained regarding consecutive patients underwent RFCA for AF,excluding those who had previous history of hypothyroidism,hyperthyroidism or ongoing medical treatment for hypothyroidism or hyperthyroidism,biochemically defined overt thyroid disease and long-term use of amiodarone prior to admission.The primary endpoint was recurrence of AF in a time-to-event analysis.We compared outcomes in patients who were with subclinical hyperthyroidism or subclinical hypothyroidism with patients of euthyroid state,using a multivariable Cox model with inverse probability weighting and propensity score matching.Results: In all,93 patients were excluded from 435 consecutive patients underwent RFCA for AF.Of the remaining 342 patients for the analysis,the prevalence of subclinical hyperthyroidism and subclinical hypothyroidism were 26(7.6%)and 41(12.0%),respectively;during a median follow-up of 489 days,91 patients(26.6%)developed a primary endpoint event.In the main analysis of the multivariable Cox model,only subclinical hyperthyroidism(HR: 3.07,95%CI: 1.54-6.14)was associated with increased risk of endpoint event after adjusting for potential confounders.However,the association between subclinical hypothyroidism and endpoint event was not significant(HR: 0.66,95%CI: 0.31-1.43).Results were consistent either in multiple sensitivity analyses or all subgroups analysis.Compared with individuals with free triiodothyronine(f T3)in the lowest quintile,those with f T3 in the highest quintile had a HR of 2.23(95%CI,1.16-4.28)for recurrence of AF.With the increase of thyroid stimulating hormone(TSH),a reduction of risk of recurrence of AF was detected in the adjusted model,and the HR per standard deviation(SD)increase was 0.82(95%CI,0.68-0.98).summary: In this retrospective cohort study involving patients underwent RFCA for AF,patients with subclinical hyperthyroidism were associated with a markedly higher prevalence of recurrence of AF,whereas patients with subclinical hypothyroidism had a similar recurrence rate of AF compared to those with euthyroid state.Part Two The Association between Insomnia and Recurrence of Atrial Fibrillation after Catheter AblationObjective: To evaluate the association between insomnia and recurrence of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods: Data were obtained regarding consecutive patients underwent RFCA for AF between January 1,2017 and June 1,2022 at our department,follow-up continued through December 1,2022,by which all the participants had completed at least 6 months of follow-up.The primary endpoint was recurrence of AF in a time-to-event analysis.We compared outcomes in patients who were with insomnia with patients without insomnia,using a multivariable Cox model with inverse probability weighting and propensity score matching.In addition,we investigated the dose-response relationship between insomnia symptoms and the endpoint of AF recurrence.In further,we used restricted cubic spline curves based on Cox proportional hazards models to flexibly model the association between sleep duration and recurrence of AF.Results: In all,185 patients were excluded from 541 consecutive patients underwent RFCA for AF.Of the remaining 356 patients for the analysis,the prevalence of insomnia was 68(19.1%),the sleep duration in insomnia group was significantly shorter than that of non-insomnia group(5.79±1.53 hours vs 7.11±1.16 hours,P=0.008).The median follow-up time of the 356 patients was 755 days(maximum 1780 days),during follow-up,one patient died and 130 patients(36.5%)developed the primary endpoint event.In the main analysis of the multivariable Cox model,insomnia was associated with increased risk of AF recurrence after adjusting for potential confounders(HR: 1.83,95%CI: 1.16-2.89).However,the association between insomnia and AF recurrence was not significant within 1 year after RFCA in the landmark analysis(HR: 1.14,95% CI: 0.54-2.41),on the contrary,there was a significant association between insomnia and the risk of recurrence of AF with longer follow-up time(HR: 2.21,95% CI: 1.18-4.16).As the number of insomnia symptoms increased,the risk of recurrence of AF increased significantly(HR: 1.34,95%CI: 1.09-1.64,P=0.005).Results were consistent either in multiple sensitivity analyses or subgroup analysis.When sleep duration was less than 7 hours(median sleep duration),the risk of AF recurrence was significantly increased with sleep duration decreased(HR: 1.32,95%CI: 1.06-1.66,P=0.013);however,when the sleep duration was more than 7 hours,sleep duration was not significantly associa-ted with the risk of AF recurrence(HR: 1.38,95%CI: 0.65-2.86,P=0.406).Summary: Insomnia is independently associated with an increased risk of long-term recurrence of AF after RFCA.Insomnia is a common,easily identified,and potentially modifiable disorder,our findings underscore the importance of early detection and comprehensive management of insomnia in patients with AF who intend to undergo RFCA.Part Three The Association between Ivabradine therapy and Recurrence of Atrial Fibrillation after Catheter AblationObjective: To evaluate the association between ivabradine therapy and recurrence of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods: Frist,the study protocol was registered in the Chinese Clinical Trial Register(Registration number: Chi CTR2100052741).Then,data were obtained prospectively regarding consecutive patients underwent RFCA for AF between January 1,2021 and July 1,2022 at our department,follow-up continued through January 1,2023,by which all the participants had completed at least 6 months of follow-up.The primary endpoint was recurrence of AF in a time-to-event analysis.We used four statistical models,including multivariate Cox proportional hazards model,multivariate Cox proportional hazards model after propensity score matching,time-varying multivariate Cox proportional hazards model and marginal structure Cox model,to investigate the correlation between ivabradine therapy and recurrent of AF after RFCA.Results: In all,97 patients were excluded from 274 consecutive patients underwent RFCA for AF.Of the remaining 177 patients for the analysis,58(32.8%)were treated with ivabradine and 119(67.2%)were not.The median treatment time of ivabradine was 118 days(range: 61-430 days),and the daily dose was 9.0±1.8mg.The median follow-up time of the 177 patients was 160 days(maximum 461 days),during follow-up,26 patients(14.8%)developed the primary endpoint event.In the main analysis of the multivariable Cox model,we did not find a significant association between ivabradine therapy and recurrent of AF after RFCA in the crude,minimal adjusted model,and fully adjusted model(HR: 0.80,95% CI: 0.21-3.13,P=0.751).The same result was obtained in the propensity score matching analysis(HR: 1.45,95% CI: 0.12-17.34,P=0.769).Results were consistent either in the time-varying multivariate Cox proportional hazards model(HR: 2.09,95% CI: 0.37-11.78,P=0.405)or in the marginal structure Cox model(HR: 1.55,95% CI: 00.26-9.12,P=0.628).summary: In summary,we don’t identify a significant association between ivabradine therapy and recurrence of AF after RFCA,and this conclusion needs to be confirmed by larger studies in future.Conclusions:1.Compared to those with euthyroid state,patients with subclinical hyperthyroidism were associated with a markedly higher prevalence of recurrence of AF,whereas patients with subclinical hypothyroidism had a similar recurrence rate of AF.2.Insomnia is independently associated with an increased risk of longterm recurrence of AF after RFCA.3.We don’t identify a significant association between ivabradine therapy and recurrence of AF after RFCA,and this conclusion needs to be confirmed by larger studies in future. |
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