Catheter ablation of atrial fibrillation in patients with psoriasis: a multicenter study

Abstract Background Psoriasis is linked to an increased risk of atrial fibrillation (AF). However, data on the electrophysiological substrate and outcomes of AF ablation in patients with psoriasis are lacking. Methods We conducted a retrospective, multicenter study involving 48 patients with psoriasis (median age, 66 [56-72]years; 79% male) and paroxysmal (n=25, 52%) or persistent AF (n=23, 48%) who underwent ablation at four high-volume institutions between 2018 and 2023. Propensity score-matching identified 96 controls patients without psoriasis undergoing AF ablation at the same institutions. The primary endpoint was survival free from atrial tachyarrhythmia recurrence (AT) after an 8-week blanking period. Results Baseline clinical characteristics were well balanced between groups. However, psoriasis patients had higher C-reactive protein (CRP) than controls(0.85 [0.45-1.2] mg/dl vs. 0.3 [0.3-0.4] mg/dl, p<0.001) and a greater burden of left atrial low-voltage regions at electroanatomical mapping (20 [11-20]% vs. 5 [5-10]%; p=0.013). Over a median follow-up of 20 (13-32) months, AT recurrence occurred in a higher proportion of psoriasis patients, both on (40% vs 24%, log-rank p=0.023, Figure 1) and off antiarrhythmic drugs (log-rank p=0.024). Patients with psoriasis also had a slightly higher risk of acute coronary syndrome (log-rank p=0.045), with similar risks of death (log-rank p=0.517) and procedural complications (2% vs. 2%,p=1.000), while no stroke occurred. Multivariable analysis identified early recurrence within blanking period (aHR=5.88, p<0.001), pre-ablation CRP levels (aHR=1.17, p=0.016), and psoriasis history (aHR=2.20, p=0.046) as predictors of AT recurrence. In the psoriasis group, the optimal CRP cutoff associated with AT recurrence was found to be 1mg/dl (Figure 2). Conclusion Psoriasis is associated with low-grade systemic inflammation, more severe electroanatomical markers of atrial cardiomyopathy, and worse post-ablation outcomes. The association between CRP levels and rhythm outcomes suggests that inflammation may drive recurrences among psoriasis patients undergoing AF ablation.Figure.Survival free from AT recurrence AT recurrence according to CRP levels