Catheter ablation of atrial fibrillation in patients with psoriasis: a multicenter study

Background: Psoriasis is linked to an increased risk of atrial fibrillation (AF). However, data on the electrophysiological substrate and outcomes of AF ablation in patients with psoriasis are lacking. Methods: We conducted a retrospective, multicenter study involving 48 patients with psoriasis (median age, 66 years [56-72]; 79% male) and paroxysmal (n=25.52%) or persistent AF (n=23.48%) who underwent ablation at 4 high-volume institutions between 2018 and 2023. Propensity score-matching identified 96 controls without psoriasis undergoing AF ablation at the same institutions. The primary end point was survival free from atrial tachyarrhythmia recurrence after an 8-week blanking period. Results: Baseline clinical characteristics were well balanced between groups. However, patients with psoriasis had higher CRP (C-reactive protein) than controls (0.85 mg/dL [0.45-1.2] versus 0.3 mg/dL [0.3-0.4], P<0.001) and a greater burden of left atrial low-voltage regions at electroanatomical mapping (20% [11%-20%] versus 5% [5%-10%]; P=0.013). Over a median follow-up of 20 (13-32) months, atrial tachyarrhythmia recurrence occurred in a higher proportion of patients with psoriasis (40% versus 24%, log-rank P=0.023). Patients with psoriasis also had a slightly higher risk of acute coronary syndrome (log-rank P=0.045), with similar risks of death (log-rank P=0.517) and procedural complications (2% versus 2%, P=1.000), whereas no stroke occurred. Multivariable analysis identified early recurrence within blanking period (adjusted hazard ratio [aHR], 5.9, P<0.001), preablation CRP levels (aHR, 1.2, P=0.016), and psoriasis history (aHR, 2.2, P=0.046) as predictors of atrial tachyarrhythmia recurrence. In the group with psoriasis, the optimal CRP cutoff associated with atrial tachyarrhythmia recurrence was found to be 1 mg/dL. Conclusions: Psoriasis is associated with low-grade systemic inflammation, more severe electroanatomical markers of atrial cardiomyopathy, and worse postablation outcomes. The association between CRP levels and rhythm outcomes suggests that inflammation may drive recurrences among patients with psoriasis undergoing AF ablation.