Periodontitis and the outcome of atrial fibrillation ablation: Porphyromonas gingivalis is related to atrial fibrillation recurrence

Anti-Porphyromonas gingivalis Antibody Levels in Patients With Stroke and Atrial Fibrillation: A Systematic Review and Meta-Analysis

OBJECTIVES

Atrial fibrillation (AF) and stroke are two highly related conditions, with periodontitis and periodontal pathogens, such as Porphyromonas gingivalis (Pg), appearing to be the most prominent common risk factors. In this study, we evaluated studies assessing Pg infection via serum/plasma anti-Pg antibodies in patients with AF and/or stroke.

MATERIAL AND METHODS

Online databases (PubMed, Scopus, Embase, and the Web of Science) were screened for studies showing the association between anti-Pg antibodies with stroke and/or AF. Relevant data were extracted, and a subsequent random-effects meta-analysis was performed to calculate the pooled odds ratio (OR) or standardized mean difference (SMD) and 95% confidence intervals (CIs) for Pg seropositivity or anti-Pg antibody levels in stroke patients compared to controls.

RESULTS

Sixteen studies were included in the systematic review. Based on the meta-analysis performed, there was no significant difference in Pg IgA and IgG levels between patients with stroke and controls (IgA: SMD 0.11, 95% CI -0.02 to 0.25, p = 0.1; IgG: SMD -0.12, 95% CI -1.24 to 0.99, p = 0.83). Similarly, no difference was observed between these groups in terms of Pg IgA and IgG seropositivity (IgA: OR 1.63, 95% CI 1.06-2.50, p = 0.026; IgG: OR 2.30, 95% CI 1.39-3.78, p < 0.001). Subsequently, we reviewed the results of six articles investigating serum or plasma IgG antibodies against Pg in patients with AF. Our results revealed a strict association between Pg infection and AF, with AF patients exhibiting either higher anti-Pg antibody levels or a higher prevalence of positive serum Pg antibodies.

CONCLUSIONS

Our study supports the clinical utility of Pg infection assessment in patients with periodontitis and those with AF and solicits more focused studies to corroborate its use in clinical settings to enhance overall outcomes, reduce the risk of complications like stroke, and help fine-tune personalized therapies.

Periodontal Treatment During the Blanking Period Improves the Outcome of Atrial Fibrillation Ablation

BACKGROUND

Periodontitis has not been recognized as a modifiable risk factor for atrial fibrillation (AF). This prospective nonrandomized study investigated whether periodontal treatment improves the AF ablation outcome.

METHODS AND RESULTS

We prospectively enrolled 288 AF patients scheduled to undergo initial radiofrequency catheter ablation. Each patient underwent periodontal inflamed surface area (PISA; a quantitative index of periodontal inflammation) measurement. All eligible patients were recommended to receive periodontal treatment within the blanking period, and 97 consented. During the mean follow-up period of 507±256 days, 70 (24%) AF recurrences were documented. Patients who exhibited AF recurrences had a higher PISA than those who did not (456.8±403.5 versus 277.7±259.0 mm2, P=0.001). These patients were categorized into high-PISA (>615 mm2) and low-PISA (<615 mm2) groups according to the receiver operating characteristic analysis for AF recurrence (area under the curve, 0.611; sensitivity, 39%; specificity, 89%). A high PISA, as well as female sex, AF duration, and left atrial volume, were the statistically significant predicter for AF recurrence (hazard ratio [HR], 2.308 [95% CI, 1.234-4.315]; P=0.009). In patients with a high PISA, those who underwent periodontal treatment showed significantly fewer AF recurrences (P=0.01, log-rank test). The adjusted HR of periodontal treatment for AF recurrence was 0.393 (95% CI, 0.215-0.719; P=0.002).

CONCLUSIONS

Periodontitis may serve as a modifiable risk factor for AF. PISA is a hallmark of AF recurrence, and periodontal treatment improves the AF ablation outcome, especially for those with poor periodontal condition.

Effects of Oral Inflammatory Diseases and Oral Hygiene on Atrial Fibrillation: A Systematic Review

Objective. Research evidence suggests a link between periodontitis (PD) and atrial fibrillation, but the nature of this link is unclear. This study aimed to systematically review and evaluate the association between PD, other oral diseases, and atrial fibrillation and the role of oral hygiene in preventing atrial fibrillation. Methods. We searched the Medline, Embase, Cochrane Library, and Web of Science databases for the clinical study of oral health and atrial fibrillation from inception to November 2022. Oral health conditions included PD and other oral inflammatory diseases, regular oral hygiene, and tooth brushing. The primary outcomes were the risk of new-onset atrial fibrillation in patients with oral disease, the effect of regular oral care on preventing atrial fibrillation, the effect of frequent tooth brushing on preventing atrial fibrillation, and the incidence of atrial fibrillation in PD patients. Results. Eight clinical trials with a total of 4,328,355 patients were included. The result of the research showed that PD and other impaired oral health may be associated with new-onset atrial fibrillation, and its severity was dose-responsive to the risk of atrial fibrillation. The incidence of atrial fibrillation in patients with severe PD was about 16.3%. Moreover, PD may increase the risk of long-term arrhythmia in patients with atrial fibrillation. Regular oral care and frequent tooth brushing can reduce the incidence of atrial fibrillation. Conclusion. Regular and moderate oral hygiene, frequent tooth brushing, and prevention of PD and other oral inflammatory diseases could reduce the occurrence of atrial fibrillation. It is recommended to strengthen the popularization of oral health knowledge in the publicity related to atrial fibrillation.

Periodontitis was associated with worse clinical outcomes after catheter ablation for paroxysmal atrial fibrillation

Background

Periodontitis (PD), a common chronic inflammatory disease, may be associated with the subsequent development of atrial fibrillation (AF) through a mechanism of systemic inflammation. However, little is known about the impact of PD on the recurrence of atrial fibrillation after catheter ablation (CA).

Methods

A total of 132 patients (age 62.2 ± 10.6 years; 72.7% male) who underwent periodontal examinations and the first CA for paroxysmal atrial fibrillation (PAF) were investigated. Clinical periodontal examination was performed by independent trained periodontists, and patients were diagnosed with PD when the maximum periodontal probing depth was equal to or greater than 4 mm and bleeding on probing was evident. Of these, 71 patients (54%) were categorized as those with PD (PD group) and the other 61 (46%) as those without PD (non-PD group). Pulmonary vein isolation was performed in a standard fashion.

Results

Kaplan-Meier curve analysis revealed worse atrial arrhythmia recurrence-free survival probabilities after CA for PAF in the PD group than in the non-PD group (64.8% versus 80.3%, respectively; p = 0.024) during a median follow-up period of 3.0 (interquartile range: 1.1-6.4) years. Cox regression analysis revealed PD as a significant predictor of arrhythmia recurrence (hazard ratio: 2.063, 95% confidence interval: 1.018-4.182), after adjusting for age and gender.

Conclusion

Periodontitis was independently associated with an increased risk of arrhythmia recurrence after the first CA for PAF. Our results may suggest that the periodontal status is potentially a modifiable determinant of the outcomes after PAF ablation, and further prospective studies are warranted.

Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation: Histological Evaluation of Left Atrial Appendages

BACKGROUND

Atrial fibrosis contributes to the onset and persistence of atrial fibrillation (AF) and AF-related stroke. Periodontitis, a common infectious and inflammatory disease, aggravates some systemic diseases. However, the association of periodontitis with AF and with atrial fibrosis has remained unclarified.

OBJECTIVES

The authors aimed to elucidate the relationship between periodontitis and atrial fibrosis by studying resected left atrial appendages (LAAs).

METHODS

Seventy-six patients with AF (55 with nonparoxysmal AF, 25 with mitral valve regurgitation, 18 with LAA thrombus) who were scheduled to undergo LAA excision during cardiac surgery were prospectively enrolled. All patients underwent an oral examination, and the remaining number of teeth, bleeding on probing, periodontal probing depth, and periodontal inflamed surface area (PISA) were evaluated as parameters of periodontitis. The degree of fibrosis in each LAA was quantified by Azan-Mallory staining.

RESULTS

Bleeding on probing (R = 0.48; P < 0.0001), periodontal probing depth of ≥4 mm (R = 0.26; P = 0.02), and PISA (R = 0.46; P < 0.0001) were positively correlated with atrial fibrosis. Among patients with >10 remaining teeth, PISA was positively and strongly correlated with atrial fibrosis (R = 0.57; P < 0.0001). After adjustments for age, AF duration, BMI, mitral valve regurgitation, and CHADS₂ (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) score, PISA was significantly associated with atrial fibrosis (β = 0.016; P = 0.0002).

CONCLUSIONS

The authors histologically revealed the association of periodontitis with atrial fibrosis. This indicates that periodontitis, which is modifiable, is likely a risk factor for AF.