Clinical relationship between anemia and atrial fibrillation recurrence after catheter ablation without genetic background

Min Kim, Myunghee Hong, Jong Youn Kim, In Soo Kim, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Boyoung Joung, Moon Hyoung Lee, Hui Nam Pak

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7 Citations (Scopus)


Background: Anemia is a known adverse prognostic factor among patients with cardiovascular diseases. We investigated whether the hemoglobin level was associated with the rhythm outcome after atrial fibrillation (AF) catheter ablation (AFCA). Methods: We included 2627 patients who underwent AFCA and a guidelines-based rhythm follow-up (age 58 ± 10.9 years, 73% men, 30.6% with persistent AF), and evaluated the association of pre-AFCA anemia (haemoglobin <13 g/dL in men and <12 g/dL in women) and rhythm outcomes. We studied the mechanistic relationship between anemia and AF recurrence using a Mendelian randomization analysis (1775 subjects with genome-wide association study) after reviewing already proven 12 hemoglobin-associated genetic polymorphisms. Results: The body mass index, paroxysmal AF, warfarin use, and baseline red cell distribution width were independently associated with anemia in patients with AF. During a 23-month follow-up (interval OR 9–48 months), the clinical AF recurrence rate was significantly higher in patients with than without anemia (log-rank p = 0.001; propensity score-matched log-rank p = 0.004). This pattern was more significant in male patients (Log-rank p < 0.001) or patients with paroxysmal AF (Log-rank p < 0.001). Anemia (hazard ratio [HR] 1.45 [1.17–1.80], p = 0.001), left atrial diameter (HR 1.03 [1.01–1.04], p < 0.001), a female sex (HR 1.17 [1.00–1.36], p = 0.047), and persistent AF (HR 1.58 [1.36–1.84], p < 0.001) were independently associated with post-AFCA clinical recurrence. In the Mendelian randomization, we could not find a significant direct causal relationship between anemia and AF recurrence at the genetic level. Conclusions: Pre-AFCA anemia is an independent predictor of post-AFCA clinical recurrence, especially in male patients, without a genetically direct causal relationship.

Original languageEnglish
Article number100507
JournalIJC Heart and Vasculature
Publication statusPublished - 2020 Apr

Bibliographical note

Funding Information:
This work was supported by grants ( HI18C0070 and HI19C0114 ) from the Ministry of Health and Welfare and a grant ( NRF-2017R1A2B4003983 ) from the Basic Science Research Program of the National Research Foundation of Korea (NRF), which is funded by the Ministry of Science, ICT, & Future Planning (MSIP).

Publisher Copyright:
© 2020 The Authors

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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