Impact of Coronary Artery Disease on The Outcomes of Catheter Ablation in Patients with Atrial Fibrillation

Fuqian Guo; Caiying Li; Chen Chen; Jiqiong Ni; Lan Yang; Yi-Cheng Chen; Rong Fu; Yang Jiao; Yuanyuan Meng

doi:10.21470/1678-9741-2021-0537

December 9, 2022Brazilian Journal of Cardiovascular SurgeryOpen Access

Impact of Coronary Artery Disease on The Outcomes of Catheter Ablation in Patients with Atrial Fibrillation

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Why the study?

The study was conducted to investigate the potential impact of coronary artery disease on clinical outcomes following catheter ablation in patients with atrial fibrillation.

Does concomitant coronary artery disease impact the clinical outcomes and recurrence of atrial fibrillation after catheter ablation in patients with AF?

Structured PICO

Does concomitant coronary artery disease impact the clinical outcomes and recurrence of atrial fibrillation after catheter ablation in patients with AF?

P

Population

243 patients with atrial fibrillation (AF) who underwent coronary computed tomography and catheter ablation, including 100 (41%) with coronary artery disease (CAD).

I

Intervention

Catheter ablation in patients with concomitant coronary artery disease (CAD)

C

Comparator

Catheter ablation in patients without coronary artery disease (CAD)

O

Outcome

Atrial fibrillation recurrence and adverse clinical outcomeshard clinical

Concomitant coronary artery disease in patients undergoing AF ablation is associated with worse overall clinical outcomes, despite not significantly increasing the risk of AF recurrence.

Implication

May warrant closer post-ablation surveillance in AF with CAD; leaves open CAD's independent effect on composite outcomes.

Abstract

INTRODUCTION: The objective of this study is to investigate the possible impact of coronary artery disease (CAD) on clinical outcomes of catheter ablation in patients with atrial fibrillation (AF). METHODS: Patients with AF who underwent coronary computed tomography and catheter ablation were enrolled. The presence of stenotic severity and plaque, characteristics of coronary arteries, clinical data, and adverse outcomes of catheter ablation were analysed. RESULTS: A total of 243 patients were enrolled, 100 (41%) patients with CAD. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, and sex category) score of AF patients with CAD was significantly (P<0.001) higher than of those without CAD. Presence of stenotic artery and plaques increased significantly with increase of CHA2DS2-VASc score (P<0.05). There was no significant (P=0.342) difference in AF recurrence between patients with and without CAD (30% versus 24%). Age, AF type, duration of AF, heart failure, CHA2DS2-VASc score, left ventricular ejection fraction, and left atrial diameter were significantly (P<0.05) correlated with AF recurrence in univariant analysis. Multivariable analysis revealed that duration of AF (hazard ratio [HR] 1.769), heart failure (HR 1.821), and left atrial diameter (HR 1.487, P=0.022) remained significant independent predictors of AF recurrence. Patients with AF and concomitant CAD were significantly (P=0.030) associated with a worse outcome. CONCLUSION: CAD concomitant with AF may be associated with a worse clinical outcome even though CAD does not significantly affect the risk of AF recurrence after ablation therapy.