Key result
Catheter ablation significantly increased hyperemic myocardial blood flow from 1.30 to 1.53 ml/g/min in patients who were in atrial fibrillation during pre-ablation CT, restoring it to levels comparable to matched controls.
Why the study?
AF patients without coronary artery stenosis often show clinical evidence of ischemia, but myocardial perfusion in AF patients has been poorly studied.
Does catheter ablation and restoration of sinus rhythm improve hyperemic myocardial blood flow in patients with atrial fibrillation?
Observational (n=174)
No
Does catheter ablation and restoration of sinus rhythm improve hyperemic myocardial blood flow in patients with atrial fibrillation?
Catheter ablation for atrial fibrillation restores hyperemic myocardial blood flow to levels comparable to patients in sinus rhythm, suggesting that AF-related perfusion abnormalities are primarily driven by the arrhythmia itself.
Supports ablation-associated perfusion recovery in AF; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Atrial fibrillation (AF) patients without coronary artery stenosis often show clinical evidence of ischemia. However myocardial perfusion in AF patients has been poorly studied. The purposes of this study were to investigate altered hyperemic myocardial blood flow (MBF) in patients with AF compared with risk-matched controls in sinus rhythm (SR), and to evaluate hyperemic MBF before and after catheter ablation using dynamic CT perfusion. METHODS: Hyperemic MBF was quantified in 87 patients with AF (44 paroxysmal, 43 persistent) scheduled for catheter ablation using dynamic CT perfusion, and compared with hyperemic MBF in 87 risk-matched controls in SR. Follow-up CT after ablation was performed in 49 AF patients. RESULTS: Prior to ablation, hyperemic MBF of patients in AF during the CT (1.29 ± 0.34 ml/mg/min) was significantly lower than in patients in SR (1.49 ± 0.26 ml/g/min, p = 0.002) or matched controls (1.65 ± 0.32 ml/g/min, p < 0.001); no significant difference was seen between patients in SR during the CT and matched controls (vs. 1.50 ± 0.31 ml/g/min, p = 0.815). In patients in AF during the pre-ablation CT (n = 24), hyperemic MBF significantly increased after ablation from 1.30 ± 0.35 to 1.53 ± 0.17 ml/g/min (p = 0.004); whereas in patients in SR during the pre-ablation CT (n = 25), hyperemic MBF did not change significantly after ablation (from 1.46 ± 0.26 to 1.49 ± 0.27 ml/g/min, p = 0.499). CONCLUSION: In the current study using stress perfusion CT, hyperemic MBF in patients with AF during pre-ablation CT was significantly lower than that in risk-matched controls, and improved significantly after restoration of SR by catheter ablation, indicating that MBF abnormalities in AF patients are caused primarily by AF itself.
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Takafuji et al. (2021) conducted an observational in Atrial fibrillation (n=174). Catheter ablation vs. Pre-ablation baseline was evaluated on Hyperemic myocardial blood flow (MBF) (p=0.004). Catheter ablation significantly increased hyperemic myocardial blood flow from 1.30 to 1.53 ml/g/min in patients who were in atrial fibrillation during pre-ablation CT, restoring it to levels comparable to matched controls.
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