Key result
Critical CAD before AF ablation predicts ~79% higher recurrence univariately but lacks independent risk.
Why the study?
The prevalence of coronary artery disease detected by pre-ablation cardiac CT and its impact, along with revascularization, on outcomes after atrial fibrillation ablation were unclear.
Does the presence of critical coronary artery disease detected by pre-procedural CT impact atrial tachyarrhythmia recurrence in patients undergoing atrial fibrillation ablation?
Cohort (n=576)
No
Does the presence of critical coronary artery disease detected by pre-procedural CT impact atrial tachyarrhythmia recurrence in patients undergoing atrial fibrillation ablation?
Hazard Ratio: 1.79 (95% CI 1.01–3.2)
Absolute Event Rate: 68.3% vs 82.1%
p-value: p=0.04
Incidental critical CAD detected by pre-ablation CT does not independently increase the risk of AF recurrence, meaning AF ablation should not be delayed or withheld in these patients.
Critical CAD on pre-ablation CT was not independently linked to AT recurrence; leaves open whether CAD modifies ablation outcomes.
AIMS: Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. METHODS AND RESULTS: All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). CONCLUSION: In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.
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Cappello et al. (2023) conducted a cohort in Atrial Fibrillation (n=576). Critical coronary artery disease (>70% stenosis) at pre-ablation CT vs. No critical coronary artery disease was evaluated on Atrial tachyarrhythmia-free survival (HR 1.79, 95% CI 1.01-3.2, p=0.04). Critical coronary artery disease detected by CT before AF ablation was a univariate predictor of arrhythmia recurrence (HR 1.79) but not an independent multivariate predictor, suggesting ablation remains beneficial in this group.
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