Hepatitis C-associated atrial and ventricular remodeling and poor ablation outcomes via persistent inflammation in atrial fibrillation patients without sustained virological response

Background

Hepatitis C virus (HCV) infection is widely recognized as a risk factor for cardiovascular disease. Recent advances in antiviral therapy have enabled most patients to achieve a sustained virological response (SVR). However, the impact of HCV infection and the achievement of SVR on clinical characteristics and atrial fibrillation (AF) ablation outcomes remains unclear.

Purpose

This study aimed to evaluate the impact of achieving SVR on inflammatory status, atrial remodeling, and ablation outcomes in patients with AF and chronic hepatitis C infection.

Methods

A total of 448 patients (mean age, 64 years; 69% male) referred for AF ablation were enrolled. Patients were assigned into three groups on HCV status: those with HCV infection without SVR (HCV without SVR; n = 6), those with HCV infection who achieved SVR (HCV with SVR; n = 12), and those without HCV infection (No-HCV; n = 430). Clinical characteristics and ablation outcomes were compared among the three groups.

Results

Compared with the No-HCV group, both HCV groups (with and without SVR) were significantly older and had a higher prevalence of left ventricular hypertrophy, larger left atrial volumes, and elevated hs-CRP and NT-proBNP levels (all P < 0.05).

Kaplan–Meier analysis demonstrated that patients with HCV without SVR had the poorest ablation outcomes (P < 0.05), whereas there was no significant difference between the HCV with SVR and No-HCV groups (P > 0.05), as shown in Figure 1.

In multivariate Cox regression analysis, HCV without SVR and hs-CRP were identified as independent predictors of worse ablation outcomes (hazard ratio: 1.860, P = 0.047; and 1.933, P = 0.013, respectively).

Conclusion

HCV infection is associated with LA and LV remodeling via persistent inflammation. The absence of SVR may contribute to worse ablation outcomes for AF.