Outcome of catheter ablation for paroxysmal atrial fibrillation in patients with stable coronary artery disease

Yi‐Kai Cui; Jianzeng Dong; Xin Du; Rong Hu; Liu He; Deyong Long; Rong Bai; Ronghui Yu; Caihua Sang; Chenxi Jiang; Nian Liu; Songnan Li; Wei Wang; Xueyuan Guo; Xin Zhao; Ribo Tang; Changsheng Ma

doi:10.1111/pace.14571

July 22, 2022Pacing and Clinical Electrophysiology

Outcome of catheter ablation for paroxysmal atrial fibrillation in patients with stable coronary artery disease

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Why the study?

AF and stable CAD frequently coexist, but the long-term outcome of catheter ablation in patients with both paroxysmal AF and stable CAD required assessment.

Does stable coronary artery disease increase the risk of atrial fibrillation recurrence and adverse clinical events after catheter ablation in patients with paroxysmal atrial fibrillation?

Structured PICO

Does stable coronary artery disease increase the risk of atrial fibrillation recurrence and adverse clinical events after catheter ablation in patients with paroxysmal atrial fibrillation?

P

Population

2,205 patients with paroxysmal atrial fibrillation undergoing catheter ablation (441 with stable coronary artery disease matched 1:4 to 1,764 without stable coronary artery disease), screened from a cohort of 12,104 patients in the Chinese Atrial Fibrillation Registry.

I

Intervention

Catheter ablation in patients with stable coronary artery disease

C

Comparator

Catheter ablation in patients without stable coronary artery disease

O

Outcome

Atrial fibrillation recurrence after single ablationhard clinical

The presence of stable coronary artery disease in patients with paroxysmal atrial fibrillation undergoing catheter ablation is associated with a significantly higher risk of AF recurrence and thromboembolic events.

Implication

Should not yet change ablation candidacy in SCAD; leaves open whether tailored surveillance reduces recurrence and thromboembolism.

Abstract

BACKGROUND: Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist. This study aimed to assess the long-term outcome of catheter ablation in patients with paroxysmal AF and SCAD. METHODS: In total, 12,104 patients with paroxysmal AF underwent catheter ablation in the Chinese Atrial Fibrillation Registry between 2011 and 2019 were screened. A total of 441 patients with SCAD were matched with patients without SCAD in a 1:4 ratio. The primary endpoint was AF recurrence after single ablation. The composite secondary endpoints were thromboembolism, coronary events, major bleeding, all-cause death. RESULTS: Over a mean follow-up of 46.0 ± 18.9 months, the recurrence rate in patients with SCAD was significantly higher after a single ablation (49.0% vs. 41.9%, p = .03). The very late recurrence rate of AF in the SCAD group was also significantly higher than that in the control group (38.9% vs. 31.2%;p = .04). In multivariate analysis, adjusted with the female, smoking, duration of AF, previous thromboembolism, COPD, and statins, SCAD was independently associated with AF recurrence (adjusted HR, 1.19 [1.02-1.40], p = .03). The composite secondary endpoints were significantly higher in the SCAD group (12.70% vs. 8.54%, p = .02), mainly due to thromboembolism events (8.16% vs. 4.41%, p < .01). CONCLUSIONS: SCAD significantly increased the risk of recurrence after catheter ablation of paroxysmal AF. The incidence of thromboembolic events after catheter ablation of paroxysmal AF in the patients with SCAD was significantly higher than that in those without SCAD.