Relationship Between Endothelial Dysfunction and the Outcomes After Atrial Fibrillation Ablation

BACKGROUND: Endothelial dysfunction (ED) is associated with cardiovascular events in patients with atrial fibrillation (AF). However, the utility of ED as a prognostic marker after AF ablation supplementary to the CHA(2)DS(2)‐VASc score is unclear. This study aimed to investigate the relationship between ED and 5‐year cardiovascular events in patients undergoing AF ablation. METHODS AND RESULTS: We conducted a prospective cohort study of patients who underwent a first‐time AF ablation and for whom the endothelial function was assessed by the peripheral vascular reactive hyperemia index (RHI) before ablation. We defined ED as an RHI of <2.1. Cardiovascular events included strokes, heart failure requiring hospitalization, arteriosclerotic disease requiring treatment, venous thromboses, and ventricular arrhythmias or sudden cardiac death. We compared the 5‐year incidence of cardiovascular events after AF ablation between those with and without ED. Among the 1040 patients who were enrolled, 829 (79.7%) had ED, and the RHI value was found to be associated with the CHA(2)DS(2)‐VASc score (P=0.004). The 5‐year incidence of cardiovascular events was higher among patients with ED than those without ED (98 [11.8%] versus 13 [6.2%]; log‐rank P=0.014). We found ED to be an independent predictor of cardiovascular events after AF ablation (hazard ratio [HR], 1.91 [95% CI, 1.04–3.50]; P=0.036) along with a CHA(2)DS(2)‐VASc score of ≥2 (≥3 for women) (HR, 3.68 [95% CI, 1.89–7.15]; P<0.001). CONCLUSIONS: The prevalence of ED among patients with AF was high. Assessing the endothelial function could enable the risk stratification of cardiovascular events after AF ablation.