Major adverse cardiovascular events and their predictors in patients with atrial fibrillation undergoing pulmonary vein isolation: the Swiss-AF-PVI study
V Herren, S Aeschbacher, G Voellmin, M Coslovsky, P Krisai, S Knecht, D Spreen, N Schaerli, B Schaer, F Mahfoud, C Sticherling, P Badertscher, M KuehneAbstract
Introduction
Pulmonary vein isolation (PVI) represents a central therapeutic strategy in patients with atrial fibrillation (AF). Although the efficacy of PVI in rhythm control is well established, data on major adverse cardiovascular events (MACE) during long-term follow-up after PVI and their predictors remain limited.
Purpose
This study aimed to determine the occurrence of MACE in patients with AF undergoing PVI, and to identify predictors of MACE during long-term follow-up after PVI.
Methods
All patients undergoing index PVI with available follow-up of ≥1 year were included. The primary outcome was the occurrence of MACE, defined as a composite of cardiovascular death, stroke, hospitalization for heart failure, or myocardial infarction. Secondary outcomes comprised the individual components of the primary endpoint, all-cause death, major and clinically relevant non-major bleeding. All outcome events were reviewed and validated by two independent physicians. Logistic regression analysis was done to investigate potential predictors for MACE.
Results
A total of 2273 patients were included. The median age was 65 years (IQR 57; 71), 683 (30.0%) were female and median CHA2DS2-VASc score was 2 (IQR 1;3). Overall, 120 patients (5.3%) experienced at least one MACE during a median follow-up of 30 months. Among the individual MACE components, cardiovascular death was the most frequent event, occurring in 50 patients (2.2%), followed by hospitalization for heart failure (n = 39, 1.7%), stroke (n = 29, 1.3%), and myocardial infarction (n = 21, 0.9%). All-cause mortality was observed in 73 patients (3.2%). Major bleeding events occurred in 33 patients (1.45%), while clinically relevant non-major bleeding was documented in 92 patients (4.1%). LVEF before index PVI (Odds Ratio (95%CI) 0.96 (0.94; 0.98), p<0.001) and regular sports (0.49 (0.29; 0.81), p<0.001) were strongly associated with MACE (Table).
Conclusion
Patients with AF undergoing PVI have a relatively low risk of major adverse cardiovascular events during follow-up. Regular physical exercise and efforts to maintain LVEF may be essential to modify risk.