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Introduction: The prevalence and significance of thoracic aorta atherosclerosis in AF patients has not been clearly defined in the literature. There are scant reports supporting an association of atherosclerotic aortic plaque burden with embolic phenomena and recurrence of AF post ablation. Two modalities of aortic atherosclerosis detection include computed tomography (CT) and echocardiography. Hypothesis: The prevalence of ascending aorta atherosclerosis in AF patients is high and CT performs better than transthoracic echocardiography in its detection. Methods: We investigated prevalence of ascending aorta atherosclerosis by CT and transthoracic echocardiography in 76 consecutive patients referred for AF ablation (67.1% males, 62.9 +/- 9.8 years old, 6.6% active smokers, 75% paroxysmal AF, 13.1% with LV ejection fraction (EF) <50%, 61.8% with hyperlipidemia, 55.8% with hypertension, 10.5% with diabetes, 2.6% with chronic kidney disease, and 1 patient with peripheral artery disease). The pre-ablation echocardiograms and cardiac CT scans, originally performed for left atrial mapping and evaluation of left atrial appendage thrombus, were reviewed in a blinded fashion for the presence of aortic atherosclerosis. Results: Out of 76 AF ablation patients, 27 (35.5%) had evidence of ascending aorta atherosclerosis by CT and 43 (56.6%) by echocardiography. Using CT as the gold standard, echocardiography had a sensitivity of 70.4% and a specificity of 51% in identification of ascending aorta atherosclerosis. Positive and negative predictive values were 44.2% and 75.8%, respectively. A total of 16 patients (21.1%) had AF recurrence post ablation, out of which 6 (37.5%) had evidence of aortic atherosclerosis on CT (vs 21/49 [42.9%] in the non-recurrence group). Conclusions: Ascending aorta atherosclerosis is common in patients referred for AF ablation. Transthoracic echocardiography likely overestimates its prevalence. Aortic atherosclerosis as detected by CT was not significantly associated with AF recurrence post ablation. More studies investigating clinical implications and best treatment approach to subclinical aortic therosclerosis in patients with AF are needed.

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