Data_Sheet_2_The Association Between Subclinical Thyroid Dysfunction and Recurrence of Atrial Fibrillation After Catheter Ablation.docx

ObjectiveThe aim of this study was to evaluate the association between subclinical thyroid dysfunction and the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).MethodsWe examined the association between subclinical thyroid dysfunction and the recurrence of AF at a large university-affiliated cardiac arrhythmia center in China. Data were collected from consecutive patients who underwent RFCA for AF, excluding those with a history of hypothyroidism, hyperthyroidism, or ongoing medical treatment for hypothyroidism or hyperthyroidism, biochemically defined overt thyroid disease, and long-term use of amiodarone before admission. The primary end point was the recurrence of AF in a time-to-event analysis. We compared outcomes in patients who had subclinical hyperthyroidism or hypothyroidism with those who had euthyroid state, using a multivariable Cox model with inverse probability weighting and propensity score matching.ResultsIn all, 93 patients were excluded from 435 consecutive patients who underwent RFCA for AF. Of the remaining 342 patients for the analysis, the prevalence of subclinical hyperthyroidism and subclinical hypothyroidism were 26 (7.6%) and 41 (12.0%), respectively; during a median follow-up of 489 days, 91 patients (26.6%) developed a primary end point event. In the main analysis of the multivariable Cox model, only subclinical hyperthyroidism [hazard ratio: 3.07, 95% confidence interval (CI): 1.54–6.14] was associated with an increased risk of end point event after adjusting for potential confounders. However, the association between subclinical hypothyroidism and the end point event was not significant (hazard ratio: 0.66, 95% CI: 0.31–1.43). Results were consistent either in multiple sensitivity analyses or across all subgroups of analysis. Compared with individuals with free triiodothyronine (fT3) in the lowest quintile, those with fT3 in the highest quintile had an HR of 2.23 (95% CI: 1.16–4.28) for recurrence of AF. With the increase of thyroid-stimulating hormone (TSH), a reduction in the risk of recurrence of AF was detected in the adjusted model, and the hazard ratio (HR) per standard deviation (SD) increase was 0.82 (95% CI: 0.68–0.98).ConclusionIn this retrospective cohort study involving patients who underwent RFCA for AF, patients with subclinical hyperthyroidism were associated with a markedly higher prevalence of recurrence of AF, whereas patients with subclinical hypothyroidism had a similar recurrence rate of AF compared to those with the euthyroid state.

本研究旨在评估亚临床甲状腺功能异常与射频消融术（RFCA）后房颤（AF）复发之间的关联。研究方法：本研究在中国一所大型大学附属心律失常中心，考察了亚临床甲状腺功能异常与房颤复发之间的关联。收集了连续进行射频消融治疗房颤的患者数据，排除既往有甲状腺功能减退、甲状腺功能亢进病史，或正在接受甲状腺功能减退或甲状腺功能亢进药物治疗，以及生化定义的显性甲状腺疾病和入院前长期使用胺碘酮的患者。主要终点为时间至事件分析中的房颤复发。利用多变量Cox模型、逆概率加权以及倾向得分匹配，比较了具有亚临床甲状腺功能亢进或甲状腺功能减退的患者与处于正常甲状腺功能状态的患者之间的结局。结果：在总共435名接受射频消融治疗房颤的患者中，共排除93名患者。在剩余的342名分析患者中，亚临床甲状腺功能亢进和亚临床甲状腺功能减退的患病率分别为26例（7.6%）和41例（12.0%）；在平均随访489天后，91名患者（26.6%）发生了主要终点事件。在多变量Cox模型的主要分析中，仅亚临床甲状腺功能亢进[危险比：3.07，95%置信区间（CI）：1.54-6.14]与调整潜在混杂因素后的终点事件增加风险相关。然而，亚临床甲状腺功能减退与终点事件之间的关联并不显著（危险比：0.66，95% CI：0.31-1.43）。无论在多次敏感性分析中还是在所有亚组分析中，结果均保持一致。与游离三碘甲状腺原氨酸（fT3）处于最低五分位数的人群相比，fT3处于最高五分位数的人群的房颤复发危险比（HR）为2.23（95% CI：1.16-4.28）。在调整模型中，随着促甲状腺激素（TSH）水平的增加，房颤复发风险降低，每增加一个标准差（SD）的TSH水平，危险比（HR）为0.82（95% CI：0.68-0.98）。结论：在涉及接受射频消融治疗房颤的患者的回顾性队列研究中，亚临床甲状腺功能亢进患者与房颤复发的显著高患病率相关，而亚临床甲状腺功能减退患者的房颤复发率与正常甲状腺功能状态的患者相似。