Eicosapentaenoic Acid and the Outcomes in Older Patients Undergoing Atrial Fibrillation Ablation

Background A lower serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio (EPA/AA) level correlates with cardiovascular events. Nevertheless, elevated serum EPA levels increase the risk of new‐onset atrial fibrillation (AF) in older patients. The relationship between the EPA/AA and outcomes post‐AF ablation remains unclear. This study investigated the impact of the EPA/AA on AF recurrence and cardiovascular events after AF ablation in older patients. Methods and Results This retrospective cohort study examined consecutive patients with AF aged ≥65 years who underwent a first‐time AF ablation. We compared the 3‐year AF recurrence and 5‐year major adverse cardiovascular event (MACE) rates between patients divided into high and low EPA/AA levels defined as above and below the median EPA/AA value before ablation. MACE was defined as heart failure hospitalizations, strokes, coronary artery disease, major bleeding, and cardiovascular death. Among the 673 included patients, the median EPA/AA value was 0.35. Compared with the low EPA/AA group, the high EPA/AA group had a significantly higher cumulative incidence of AF recurrence (39.3% versus 27.6%; log‐rank P=0.004) and lower cumulative incidence of MACE (13.8% versus 25.5%, log‐rank P=0.021). A high EPA/AA level was determined as an independent predictor of AF recurrence (hazard ratio [HR], 1.75 95% CI, 1.24–2.49; P=0.002) and MACE (HR, 0.60 [95% CI, 0.36–0.99]; P=0.046). Conclusions The EPA/AA was associated with AF recurrence and MACE after ablation in patients with AF aged ≥65 years.