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

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 CHA 2 DS 2 -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 CHA 2 DS 2 -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, CHA 2 DS 2 -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.

Predictors of the need for atrioventricular nodal ablation following redo ablation for atrial fibrillation

“…There is evidence that coronary artery disease increases the risk of AF recurrence after electrical cardioversion, 3 though at least one study found no difference in recurrence after catheter ablation 10 . In the latter study, however, adverse clinical outcomes were more common in those with ischemic heart disease.…”