Periodontitis - A modifiable risk factor for Atrial Fibrillation, finds study

A recent investigation found that there is a histological association between periodontitis and atrial fibrosis, and it is a modifiable risk factor for atrial fibrillation. The study was published in the journal JACC: Clinical Electrophysiology.  

Atrial fibrosis is one of the contributing factors to the onset and persistence of atrial fibrillation (AF) and AF-related stroke. Periodontitis which is a common infectious and inflammatory disease of the gums aggravates some systemic diseases. Though previous literature shows that periodontitis can cause systemic diseases there is uncertainty on the association of periodontitis with AF and with atrial fibrosis. Hence researchers conducted a study on resected left atrial appendages (LAAs) to elucidate the relationship between periodontitis and atrial fibrosis. 

A prospective study was conducted on Seventy-six patients with AF who were undergoing LAA excision during cardiac surgery. AF patients included 55 with nonparoxysmal AF, 25 with mitral valve regurgitation, and 18 with LAA thrombus. All patients underwent an oral examination, and an evaluation of periodontal parameters like the remaining number of teeth, bleeding on probing periodontal probing depth, and periodontal inflamed surface area (PISA). The degree of fibrosis in each LAA was quantified by Azan–Mallory staining. 

Results: 

• Atrial fibrosis was positively correlated with bleeding on probing, periodontal probing depth of ≥4 mm, and PISA.
• PISA was positively and strongly correlated with atrial fibrosis among patients with >10 remaining teeth.
• 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.

Thus, periodontitis and atrial fibrosis were histologically linked, and periodontitis is also a risk factor for AF. 

Further reading: Miyauchi S, Nishi H, Ouhara K, et al. Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation. J Am Coll Cardiol EP. null2022, 0 (0). https://doi.org/10.1016/j.jacep.2022.08.018