In a recent study published in Journal of the American Heart Associationresearchers evaluated whether periodontal treatment during the gap period enhances the success rate of atrial fibrillation (AF) ablation in patients with periodontitis.
Study: Periodontal treatment during the gap period improves the outcome of atrial fibrillation ablation. Image credit: Lightspring / Shutterstock
Record
Atrial fibrillation is the most common arrhythmia, increasing the risk of stroke, heart failure and premature death, thus reducing healthy life expectancy. While radiofrequency catheter ablation (RFCA) offers a higher AF recurrence-free survival rate than antiarrhythmic drugs, recurrences are common, especially in nonparoxysmal AF. Effective management of modifiable risk factors such as obesity, sleep apnea, diabetes, and hypertension is critical to improving RFCA outcomes. In contrast to these established factors, periodontitis has not yet been recognized as a modifiable risk factor for MS despite its association with the onset and recurrence of MS.
Further research is needed to establish a definitive causal link between periodontal treatment and improved outcomes in AF ablation, potentially leading to new preventive strategies.
About the study
The present non-randomized study conducted at Hiroshima University Hospital from April 1, 2020 to July 31, 2022, included 330 consecutive patients with AF admitted for initial RFCA. Patients underwent a periodontal examination the day before RFCA, where the periodontal inflammatory surface area (PISA) was assessed to quantify the severity of periodontitis. Those who consented underwent recommended non-surgical periodontal treatment during the gap period, especially at 1 and 3 months after RFCA. The study adhered to the principles of the Declaration of Helsinki and received ethical approval from the Hiroshima University Ethics Committee. Prior to participation, written informed consent was obtained from all patients.
Periodontal status was assessed by a dentist using standard methods to measure inflammation and extent of disease. This treatment consisted of comprehensive oral hygiene instructions and whole mouth cleaning without interruption of anticoagulation, with no observed complications. In addition, the study also aimed to measure serum antibody titers against major periodontal pathogens and inflammatory cytokines, providing a more detailed picture of the systemic effect of periodontal health.
Electrophysiological studies and RFCA procedures were performed with operators blinded to the patient’s periodontal health status, ensuring unbiased treatment and observation. Carefully planned interventions aimed at detecting AF recurrence with methodologies including electrocardiogram (ECG) and Holter monitoring.
Study results
The present study included 288 patients undergoing initial RFCA, and of these, 190 (66%) were men and 163 (57%) had paroxysmal AF. During a mean follow-up of 507±256 days, AF recurred in 70 (24%) patients. Among the participants, 97 received periodontal treatment during the gap period, while 191 did not. Baseline characteristics, including PISA, showed significant differences only in PISA scores, with the treatment group having a higher baseline PISA than the untreated group. Other factors, such as the use of antiarrhythmic drugs before and after RFCA, RFCA procedures and complications, showed no significant differences between groups.
Inflammatory markers and their relationship with AF recurrences were evaluated. Baseline serum levels of high-sensitivity C-reactive protein (hs-CRP) and various interleukins (IL-1β, IL-4, IL-6, IL-10, and IL-17A) were significantly higher in patients who experienced AF recurrences within 12 months. However, these markers were not associated with early AF recurrences. The study also assessed the relationship between periodontitis and atrial fibrillation recurrence, revealing that patients with higher PISA were more likely to experience recurrences. Receiver operating characteristic analysis yielded a PISA cutoff of 615.8 mm2, categorizing patients into high and low PISA groups. Those in the high PISA group showed significantly lower AF recurrence-free survival rates.
Further analyzes highlighted the systemic inflammation associated with high PISA levels, with these patients showing significantly elevated serum levels of inflammatory cytokines. Periodontal treatment appeared to significantly improve PISA scores, particularly in those with initially high PISA. Kaplan-Meier analyzes showed that the treatment group experienced fewer AF recurrences compared to the untreated group within 12 months, particularly those with a high baseline PISA score.
Regarding specific periodontal pathogens, its presence Porphyromonas gingivalis and Fusobacterium nucleatum was associated with higher rates of AF recurrence in patients with non-paroxysmal AF. This suggests a possible role of these pathogens in the recurrence of MS after ablation.
conclusions
In summary, this study examined the role of PISA in predicting AF recurrence after RFCA and evaluated the impact of periodontal treatment during the blind period. The findings suggest that high PISA scores are associated with an increased risk of AF recurrence, placing periodontitis as a potentially modifiable risk factor for AF. The research highlights an important link between systemic inflammation caused by periodontitis and the pathogenesis of AF, supporting the integration of dental health into the management of AF. Periodontal treatment reduced recurrence rates, emphasizing the need for comprehensive management strategies that include dental care.
