Leukocyte Telomere Length Predicts Long-Term Atrial Fibrillation Progression

In a study published in Frontiers in Cardiovascular Medicine, researchers, co-led by Qianhui Wang and Zheng Liu, found that leukocyte telomere length (LTL) was significantly associated with atrial fibrillation (AF) types, and was an independent predictive factor for progression of paroxysmal AF to persistent AF after catheter ablation.

This prospective clinical trial enrolled 154 patients with paroxysmal AF and 115 with persistent AF from June 2016 to December 2017. Participants’ baseline relative LTL was measured with quantitative real-time PCR (rt-PCT). Paroxysmal AF was defined as self- or cardioversion-terminated AF episodes within seven days and persistent AF was defined as AF episodes lasting more than seven days.

Progression from Paroxysmal to Persistent AF by Telomere Length

According to the researchers, there was a significant negative association between LTL and age (r=-0.23; P<.0010). Notably, patients with persistent AF had significantly shorter LTL versus those with paroxysmal AF. Over a mean follow-up of 854.9 ± 18.7 days, 35 of the 154 patients with paroxysmal AF progressed. The authors found that patients who progressed were older (70.9 ± 8.0 vs. 62.3 ± 10.3; P<.001) and had shorter LTL (1.2 ± 0.3 vs. 1.5 ± 0.3; P<.001) compared with those who did not.

The study’s receiver operating characteristic (ROC) curve analysis showed LTL had a sensitivity of 56.03%, a specificity of 82.04%, and an area under the curve (AUC) of 0.63 (95% CI, 0.56-0.70; P<.001) with an optimal cut-off value of 1.175.

Notably, patients with paroxysmal AF with shorter LTL (<1.175) exhibited a significantly higher rate of progression after catheter ablation (40.5% vs. 18.8%; P<.001). Additionally, LTL predicted AF progression with a hazard ratio (HR) of 2.71 (95% CI, 1.36-5.42; P=.005)—though HATCH score did not (HR, 1.02; 95% CI, 0.68-1.52; P=.923), according to the authors.

Ultimately, the researchers supported the potential value of LTL for predicting the progression of AF after catheter ablation therapy in the long-term.

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