Association betweenALDH2genotypes and atrial fibrillation recurrence following catheter ablation: prospective multicenter cohort study
Authors: Hoshiyama Tadashi , Ashikaga Keiichi , Morihisa Kenji , Ito Miwa , Oniki Kentaro , Saruwatari Junji , Ishii Masanobu , Kanazawa Hisanori , Sumi Hitoshi , Kaneko Shozo , Kiyama Takuya , Tsuruta Yuichiro , Matsunaga Kohei , Tsurusaki Yuta , Tsujita Kenichi 
Published: July 2024

Background

Alcohol, a risk factor for atrial fibrillation (AF), is metabolized by aldehyde dehydrogenase 2 (ALDH2). Notably, alcohol flushing syndrome attributed to the dysfunctional alleles ofALDH2(ALDH2-deficient variant) carriers are prevalent among East Asian populations. These patients are at risk for developing AF when accompanied with habitual alcohol consumption. However, the effect of theALDH2genotype on catheter ablation, the most successful treatment option for AF, remains unclear.

Methods

Totally 371 patients who underwent their first catheter ablation for AF were enrolled in this prospective cohort study. They were categorized into four groups based on theirALDH2genotypes and habitual alcohol consumption to understand the contribution status to their impact on the risk of AF recurrence. The primary outcome was to determine the proportion of AF recurrence among the four groups during a 1-year follow-up period using Kaplan–Meier analysis. The secondary outcome involved assessing the contributions of each group to AF recurrence and other risk factors using multivariate analysis.

Results

This study comprised 239ALDH2-wild type (147 habitual drinkers) and 132ALDH2-deficient variant carriers (31 habitual drinkers). Kaplan–Meier curves indicated thatALDH2-deficient variant carriers with habitual alcohol consumption exhibited the highest proportion of AF recurrence compared with the other groups (p<0.01). In addition, ALDH2-deficient variant itself was not associated with AF recurrence (hazard ratio [HR]=1.56, p=0.10),ALDH2-deficient variant carriers with habitual alcohol consumption exhibited a higher HR (HR=5.01, p=0.02) in multivariate analysis. Notably, it conferred a higher risk than that for ALDH2 wild-type patients with habitual alcohol consumption (HR=2.36, p=0.02).

Conclusion

While theALDH2-deficient variant itself showed no correlation with AF recurrence, it emerged as a significant risk factor for AF when accompanied with habitual alcohol consumption. Thus, abstinence from alcohol may be necessary, even after catheter ablation is performed, especially for patients with theALDH2-deficient variant.

Clinical Perspective

What is Known?

Alcohol, a risk factor for atrial fibrillation (AF), is metabolized by aldehyde dehydrogenase 2 (ALDH2); notably, alcohol flushing syndrome owing to dysfunctional alleles ofALDH2(ALDH2-deficient variant) is prevalent among East Asians.

However, the relationship betweenALDH2genotypes and AF recurrence following catheter ablation has not been clarified yet.

What the Study Adds

While theALDH2-deficient variant itself was not associated with AF recurrence, it emerged as a major risk factor for AF recurrence when accompanied with habitual alcohol consumption.

Abstinence from alcohol consumption may be necessary, even after catheter ablation, especially forALDH2-deficient variant carriers.