Advertisement

Impact of Free Thyroxine on the Outcomes of Left Atrial Ablation Procedures

Published:October 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.09.028
      The prevalence of atrial fibrillation (AF) is increased in hyperthyroidism. The degree to which thyroid hormones affect the outcomes of left atrial (LA) ablation is still unclear. From September 2010 to September 2013, 1,095 patients who underwent LA ablation (59.7% paroxysmal AF, 32.3% persistent AF, and 8.0% LA tachycardia) had their serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels measured in the 48 hours before the procedure. Patients were followed until they presented the first AF relapse after a blanking period of 3 months. TSH and FT4 were assessed as predictors of arrhythmia relapse and were adjusted for possible confounders. During a mean follow-up of 12.5 ± 7.9 months, 28.9% of patients presented an atrial arrhythmia relapse. TSH was not a predictor of relapse. In contrast, after adjustment, FT4 (median = 11.8 ng/L and interquartile range 10.6 to 14.6 ng/L) remained a predictor of relapse with 15% increase per quartile (hazard ratio 1.15, 95% confidence interval 1.03 to 1.29, p = 0.014). In conclusion, FT4 levels influence the success rate of LA ablation procedures, even when in the normal range.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Camm A.J.
        • Kirchhof P.
        • Lip G.Y.H.
        • Schotten U.
        • Savelieva I.
        • Ernst S.
        • Van Gelder I.C.
        • Al-Attar N.
        • Hindricks G.
        • Prendergast B.
        • Heidbuchel H.
        • Alfieri O.
        • Angelini A.
        • Atar D.
        • Colonna P.
        • De Caterina R.
        • De Sutter J.
        • Goette A.
        • Gorenek B.
        • Heldal M.
        • Hohloser S.H.
        • Kolh P.
        • Le Heuzey J.Y.
        • Ponikowski P.
        • Rutten F.H.
        • European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery.
        Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology.
        Eur Heart J. 2010; 31: 2369-2429
        • Auer J.
        • Scheibner P.
        • Mische T.
        • Langsteger W.
        • Eber O.
        • Eber B.
        Subclinical hyperthyroidism as a risk factor for atrial fibrillation.
        Am Heart J. 2001; 142: 838-842
        • Gammage M.D.
        • Parle J.V.
        • Holder R.L.
        • Roberts L.M.
        • Hobbs F.D.
        • Wilson S.
        • Sheppard M.C.
        • Franklyn J.A.
        Association between serum free thyroxine concentration and atrial fibrillation.
        Arch Intern Med. 2007; 167: 928-934
        • Tang R.B.
        • Liu D.L.
        • Dong J.Z.
        • Liu X.P.
        • Long D.Y.
        • Yu R.H.
        • Hu F.L.
        • Wu J.H.
        • Liu X.H.
        • Ma C.S.
        High-normal thyroid function and risk of recurrence of atrial fibrillation after catheter ablation.
        Circ J. 2010; 74: 1316-1321
        • Calkins H.
        • Kuck K.H.
        • Cappato R.
        • Brugada J.
        • Camm A.J.
        • Chen S.A.
        • Crijns H.J.
        • Damiano Jr., R.J.
        • Davies D.W.
        • DiMarco J.
        • Edgerton J.
        • Ellenbogen K.
        • Ezekowitz M.D.
        • Haines D.E.
        • Haissaguere M.
        • Hindricks G.
        • Iesaka Y.
        • Jackman W.
        • Jalife J.
        • Jais P.
        • Kalman J.
        • Keane D.
        • Kim Y.H.
        • Kirchhof P.
        • Klein G.
        • Kottkamp H.
        • Kimagai K.
        • Lindsay B.D.
        • Mansour M.
        • Marchlinski F.E.
        • McCarthy P.M.
        • Mont J.L.
        • Morady F.
        • Nademanee K.
        • Nakagawa H.
        • Natale A.
        • Nattel S.
        • Packer D.L.
        • Pappone C.
        • Prystowsky E.
        • Raviele A.
        • Reddy V.
        • Ruskin J.N.
        • Shemin R.J.
        • Tsao H.M.
        • Wilber D.
        • Heart Rhythm Society Task Force on Catheter and Surgical Ablation of Atrial Fibrillation
        2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society.
        Heart Rhythm. 2012; 9: 632-696
        • Jourda F.
        • Providência R.
        • Marijon E.
        • Bouzeman A.
        • Hireche H.
        • Khoueiry Z.
        • Cardin C.
        • Combes N.
        • Combes S.
        • Boveda S.
        • Albenque J.P.
        Contact-force guided radiofrequency vs. second-generation balloon cryotherapy for pulmonary vein isolation in patients with paroxysmal atrial fibrillation—a prospective evaluation.
        Europace. 2015; 17: 225-231
        • Providência R.
        • Marijon E.
        • Albenque J.P.
        • Combes S.
        • Combes N.
        • Jourda F.
        • Hireche H.
        • Morais J.
        • Boveda S.
        Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation.
        Europace. 2014; 16: 1137-1144
        • Verma A.
        • Novak P.
        • Macle L.
        • Whaley B.
        • Beardsall M.
        • Wulffhart Z.
        • Khaykin Y.
        A prospective, multicenter evaluation of ablating complex fractionated electrograms during atrial fibrillation (AF) identified by an automated mapping algorithm: acute effects on AF and efficacy as an adjuvant strategy.
        Heart Rhythm. 2008; 5: 198-205
        • Klein I.
        • Danzi S.
        Thyroid disease and the heart.
        Circulation. 2007; 116: 1725-1735
        • Chen Y.C.
        • Chen S.A.
        • Chen Y.J.
        • Chang M.S.
        • Chan P.
        • Lin C.I.
        Effects of thyroid hormone on the arrhythmogenic activity of pulmonary vein cardiomyocites.
        J Am Coll Cardiol. 2002; 39: 366-372
        • Machino T.
        • Tada H.
        • Sekiguchi Y.
        • Yamasaki H.
        • Kuroki K.
        • Igarashi M.
        • Naruse Y.
        • Nakano E.
        • Ito Y.
        • Kaneshiro T.
        • Yoshida K.
        • Aonuma K.
        Prevalence and influence of hyperthyroidism on the long-term outcome of catheter ablation for drug-refractory atrial fibrillation.
        Circ J. 2012; 76: 2546-2551
        • Ma C.S.
        • Liu X.
        • Hu F.L.
        • Dong J.Z.
        • Liu X.P.
        • Wang X.H.
        • Long de Y.
        • Tang R.B.
        • Yu R.H.
        • Lu C.S.
        • Fang D.P.
        • Hao P.
        • Liu X.H.
        Catheter ablation of atrial fibrillation in patients with hyperthyroidism.
        J Interv Card Electrophysiol. 2007; 18: 137-142
        • Komiya N.
        • Isomoto S.
        • Nakao K.
        • Hayano M.
        • Yano K.
        Electrophysiological abnormalities of the atrial muscle in patients with paroxysmal atrial fibrillation associated with hyperthyroidism.
        Clin Endocrinol (Oxf). 2002; 56: 39-44
        • Sgarbi J.A.
        • Villaca F.G.
        • Garbeline B.
        • Villar H.E.
        • Romaldini J.H.
        The effects of early antithyroid therapy for endogenous subclinical hyperthyroidism in clinical and heart abnormalities.
        J Clin Endocrinol Metab. 2003; 88: 1672-1677
        • Marrakchi S.
        • Kanoun F.
        • Idriss S.
        • Kammoun I.
        • Kachboura S.
        Arrhythmia and thyroid dysfunction.
        Herz. 2015; 40: 101-109
        • Fazio S.
        • Palmieri E.A.
        • Lombardi G.
        • Biondi B.
        Effects of thyroid hormone on the cardiovascular system.
        Recent Prog Horm Res. 2004; 59: 31-50
        • Ozturk S.
        • Dikbas O.
        • Baltaci D.
        • Ozyasar M.
        • Erdem A.
        • Ayhan S.S.
        • Ozlu F.
        • Alcelik A.
        • Tosun M.
        • Yazici M.
        Evaluation of atrial conduction abnormalities and left atrial mechanical functions in patients with subclinical thyroid disorders.
        Endokrynol Pol. 2012; 63: 286-293
        • Vasamreddy C.R.
        • Lickfett L.
        • Jayam V.K.
        • Nasir K.
        • Bradley D.J.
        • Eldadah Z.
        • Dickfeld T.
        • Berger R.
        • Calkins H.
        Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter.
        J Cardiovasc Electrophysiol. 2004; 15: 692-697
        • Jiang H.
        • Lu Z.
        • Lei H.
        • Zhao D.
        • Yang B.
        • Huang C.
        Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease.
        J Interv Card Electrophysiol. 2006; 15: 157-163
        • Leong-Sit P.
        • Roux J.F.
        • Zado E.
        • Callans D.J.
        • Garcia F.
        • Lin D.
        • Marchlinski F.E.
        • Bala R.
        • Dixit S.
        • Riley M.
        • Hutchinson M.D.
        • Cooper J.
        • Russo A.M.
        • Verdino R.
        • Gerstenfeld E.P.
        Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study.
        Circ Arrhythm Electrophysiol. 2011; 4: 11-14
        • McCready J.W.
        • Smedley T.
        • Lambiase P.D.
        • Ahsan S.Y.
        • Segal O.R.
        • Rowland E.
        • Lowe C.G.
        • Chom A.W.
        Predictors of recurrence following radiofrequency ablation for persistent atrial fibrillation.
        Europace. 2011; 13: 355-361
        • Heeringa J.
        • Hoogendoorn E.H.
        • van der Deure W.M.
        • Hofman A.
        • Peeters R.P.
        • Hop W.C.
        • den Heijjer M.
        • Visser T.J.
        • Witteman J.C.
        High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study.
        Arch Intern Med. 2008; 168: 2219-2224
        • Mikhaylov E.N.
        • Orshanskaya V.S.
        • Lebedev A.D.
        • Szili-Torok T.
        • Lebedev D.S.
        Catheter ablation of paroxysmal atrial fibrillation in patients with previous amiodarone-induced hyperthyroidism: a case-control study.
        J Cardiovasc Electrophysiol. 2013; 24: 888-893
        • Canaris G.J.
        • Manowitz N.R.
        • Mayor G.
        • Ridgway E.C.
        The Colorado thyroid disease prevalence study.
        Arch Intern Med. 2000; 160: 526-534
        • Hollowell J.G.
        • Staehling N.W.
        • Flanders W.D.
        • Hannon W.H.
        • Gunter E.W.
        • Spencer C.A.
        • Braverman L.E.
        Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III).
        J Clin Endocrinol Metab. 2002; 87: 489-499
        • Surks M.I.
        • Sievert R.
        Drugs and thyroid function.
        N Engl J Med. 1995; 333: 1688-1694
        • Vanderpump M.P.
        Should we treat mild subclinical/mild hyperthyroidism? No.
        Eur J Intern Med. 2011; 22: 330-333
        • Santos Palacios S.
        • Pascual-Corrales E.
        • Galofre J.C.
        Management of subclinical hyperthyroidism.
        Int J Endocrinol Metab. 2012; 10: 490-496
        • Wiersinga W.M.
        Should we treat mild subclinical/mild hyperthyroidism? Yes.
        Eur J Intern Med. 2011; 22: 324-329