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Periodontitis: An independent risk factor for AF

Presented By
Prof. Shunsuke Miyauchi, Hiroshima University, Japan
AHA 2022

Histological assessment of left atrial appendages in patients with periodontitis revealed an association between the degree of periodontitis and atrial fibrosis, a dominant factor for the development of atrial fibrillation (AF). The correlation of AF with periodontal inflamed surface area remained positive after adjustment for known risk factors.

Periodontitis, a common inflammatory and infectious disease of the gums, has been shown to aggravate some systemic diseases. Until now, the association of periodontitis with both atrial fibrosis, which contributes to the onset and persistence of AF, and AF remains unclear [1]. To elucidate a possible relationship between periodontitis and atrial fibrosis, Prof. Shunsuke Miyauchi (Hiroshima University, Japan) and his team studied resected left atrial appendages of 76 participants with AF following atrial appendage excision [2]. Additionally, all participants underwent an oral examination evaluating the remaining number of teeth, bleeding on probing (BOP), periodontal probing depth, and periodontal inflamed surface area (PISA). PISA depicts the sum of all the areas of bleeding in the periodontal pocket epithelium and reflects the quantification of clinical periodontal inflammation degree. In addition, the degree of left atrial appendage fibrosis was quantified histologically by Azan-Mallory staining in sections randomly resected from the distal side of each left atrial appendage.

The researchers found that 3 periodontitis-suggesting parameters were positively correlated with atrial fibrosis, namely BOP (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). Among patients with >10 remaining teeth, PISA was positively and strongly correlated with atrial fibrosis (r=0.57; P<0.0001). Also after adjusting the results for known risk factors of AF, such as age, AF duration, body mass index, mitral valve regurgitation, and CHADS₂ (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) score, PISA was still significantly associated with atrial fibrosis (P=0.0002).

The authors concluded that there is a positive association of periodontitis with atrial fibrosis, especially in the presence of distinct inflammation. Periodontitis should be considered a modifiable risk factor for AF.

    1. Xintarakou A, et al. Europace. 2020;22(3):342–351
    2. Miyauchi S, et al. Relationship between periodontitis and atrial fibrosis in atrial fibrillation: Histological evaluation of left atrial appendages. EA.APS.P270, AHA Scientific Sessions 2022, Chicago, USA, 05–07 November.


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