22 February 2023

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Gum infection may be a risk factor for cardiac arrhythmia

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Periodontitis, a gum disease, can lead to a litany of dental problems, from bad breath to bleeding and tooth loss. Now, researchers at Hiroshima University have discovered that it could be linked to even more serious problems in another part of the body: the heart.

In a study published Oct. 31 in JACC: Clinical Electrophysiology, the team found a significant correlation between periodontitis and fibrosis (scarring of an appendix of the heart's left atrium that can cause an irregular heartbeat called atrial fibrillation) in a sample of 76 patients with heart disease.

"Periodontitis is associated with long-lasting inflammation, and inflammation plays a key role in the progression of atrial fibrosis and the pathogenesis of atrial fibrillation," said first author Shunsuke Miyauchi, an assistant professor at the Center for Health Services at Hiroshima University. He is also affiliated with the university's Graduate School of Biomedical and Health Sciences. "Our hypothesis was that periodontitis exacerbates atrial fibrosis. This histological study of the left atrial appendages aimed to clarify the relationship between the clinical status of periodontitis and the degree of atrial fibrosis."

The patients' left atrial appendages were surgically removed, and the researchers analyzed the tissue to establish the correlation between the severity of atrial fibrosis and the severity of gum disease. They found that the worse the periodontitis, the worse the fibrosis, suggesting that inflammation of the gums can intensify inflammation and disease in the heart.

"This study provides basic evidence that periodontitis can aggravate atrial fibrosis and constitute a new modifiable risk factor for atrial fibrillation," said Yukiko Nakano, study author and professor of cardiovascular medicine at Hiroshima University's School of Biomedical and Health Sciences.

According to Nakano, in addition to improving other risk factors such as weight, activity levels and tobacco and alcohol use, periodontal care could help in the comprehensive treatment of atrial fibrillation. However, he cautioned that this study did not establish a cause-and-effect relationship, meaning that while degrees of severity of gum disease and atrial fibrosis appear to be related, researchers haven't found that one leads definitively to the other.

"More evidence is needed to establish that periodontitis contributes to atrial fibrosis causally and that periodontal care may alter fibrosis," Nakano said. "One of our goals is to confirm that periodontitis is a modifiable risk factor for atrial fibrillation and to promote the involvement of dental specialists in the comprehensive treatment of atrial fibrillation. Periodontitis is an easily modifiable and lowest cost target among known atrial fibrillation risk factors. Thus, achieving this series of studies may bring benefits to many people around the world."

Next, the researchers said they hope to conduct future clinical trials to clarify whether periodontal intervention reduces the occurrence of atrial fibrillation and improves patient outcomes.

This article was originally published in Odontologia33. 

Shunsuke Miyauchi et al. "Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation: Histological Evaluation of Left Atrial Appendages." J Am Coll Cardiol EP. 2023 Jan, 9 (1) 43–53. doi/10.1016/j.jacep.2022.08.018