Treating gingivitis after defibrillation reduces risk of AFib recurrence, study finds

Treating gum disease within three months of a procedure to correct an irregular heartbeat known as atrial fibrillation (AFib) can reduce oral inflammation and may reduce the recurrence of AFib, according to new research published today in Journal of the American Heart Association.

According to the US Centers for Disease Control and Prevention (CDC), about half of American adults age 30 and older have some form of periodontal disease or gingivitis, with the incidence increasing with age.

This study is one of the first to investigate the potential impact of gum disease treatment on AFib. AFib is a condition in which the heart beats irregularly, increasing the risk of stroke by five times. More than 12 million people in the US are expected to have AFib by 2030, according to the American Heart Association’s 2024 Heart Disease and Stroke Statistics.

“Gum disease can be modified by dental intervention. Proper management of gingivitis appears to improve the prognosis of AFib, and many people around the world could benefit from it,” said lead study author Shunsuke Miyauchi, MD, Ph.D. assistant professor at Hiroshima University Health Services Center in Japan involved in general cardiology, arrhythmia practice and research.

Researchers followed 97 patients who had undergone the non-surgical procedure to correct AFib (ablation with a radiofrequency probe) and were treated for gingivitis, along with 191 ablation patients who were not treated for gingivitis. Catheter ablation is a procedure that uses radio frequency energy to destroy a small area of ​​heart tissue causing fast and irregular heartbeats. This study found that a marker measuring the severity of gum inflammation was associated with the return of AFib.

After the ablation procedure, during a mean follow-up period of between 8.5 months and 2 years, researchers found:

• AFib recurred in 24% of all participants throughout the follow-up period.
• Patients with severe gingivitis who were treated after heart catheter ablation were 61% less likely to experience AFib recurrence, compared with ablation patients who did not receive treatment for severe gingivitis.
• Patients who had AFib relapses had more severe gingivitis than those without relapses.
• Having gingivitis, being female, having an irregular heartbeat for more than two years, and having a left atrial tumor were predictors of AFib recurrences. A left atrial tumor often leads to AFib recurrence as it involves thickening and scarring of the connective tissues, Miyauchi explained.

Miyauchi noted, “While the main findings were in line with their expectations, we were surprised how useful a quantitative marker of gum disease, known as periodontal inflammatory surface, or PISA, could be in cardiovascular clinical practice.”

While the American Heart Association does not recognize oral health as a risk factor for heart disease, recognizes that oral health can be an indicator of overall health and wellness. Bacteria from inflamed teeth and gums can travel through the bloodstream to the rest of the body, including the heart and brain. Chronic gum inflammation can be associated with other systemic health conditions, such as coronary heart disease, stroke and type 2 diabetes.

Study details and history:

• A total of 288 adults (66% men, 34% women) treated for AFib were enrolled in this study.
• The single-center study was conducted from April 1, 2020, to July 31, 2022, at Hiroshima University Hospital in Hiroshima, Japan, and all participants were Asian.
• Enrollees were examined by a dentist before undergoing catheter ablation for AFib.

“We are now working on further research to uncover the mechanism behind the relationship between gum disease and AFib,” Miyauchi said.

Study limitations include: a small number of patients enrolled from a single center; Patients were not randomized to receive dental treatment. Periodontal status was not monitored after baseline among participants who did not receive treatment for gum disease. and inflammatory markers were not reassessed after the ablation procedure.