Association between ALDH2 genotypes and atrial fibrillation recurrence following catheter ablation: prospective multicenter cohort study

BackgroundAlcohol, a risk factor for atrial fibrillation (AF), is metabolized by aldehyde dehydrogenase 2 (ALDH2). Notably, alcohol flushing syndrome attributed to the dysfunctional alleles of ALDH2 (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 the ALDH2 genotype on catheter ablation, the most successful treatment option for AF, remains unclear. MethodsTotally 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 their ALDH2 genotypes 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. ResultsThis study comprised 239 ALDH2-wild type (147 habitual drinkers) and 132 ALDH2-deficient variant carriers (31 habitual drinkers). Kaplan-Meier curves indicated that ALDH2-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). ConclusionWhile the ALDH2-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 the ALDH2-deficient variant. Clinical PerspectiveO_ST_ABSWhat is Known?C_ST_ABSO_LIAlcohol, a risk factor for atrial fibrillation (AF), is metabolized by aldehyde dehydrogenase 2 (ALDH2); notably, alcohol flushing syndrome owing to dysfunctional alleles of ALDH2 (ALDH2-deficient variant) is prevalent among East Asians. C_LIO_LIHowever, the relationship between ALDH2 genotypes and AF recurrence following catheter ablation has not been clarified yet. C_LI What the Study AddsO_LIWhile the ALDH2-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. C_LIO_LIAbstinence from alcohol consumption may be necessary, even after catheter ablation, especially for ALDH2-deficient variant carriers. C_LI