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Espersen C, Modin D, Johansen ND, Janstrup KH, Johannessen A, Hansen J, Eskesen K, Iversen AZ, Worck RH, Ruwald MH, Hansen ML, Gislason GH, San José Estépar R, Marcus GM, Biering-Sørensen T. Prognostic importance of ischemic heart disease for patients with atrial fibrillation undergoing catheter ablation. Heart Rhythm 2024:S1547-5271(24)03141-2. [PMID: 39147302 DOI: 10.1016/j.hrthm.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Ischemic heart disease (IHD) has been linked to an increased risk of atrial fibrillation (AF). However, data are sparse regarding the role of IHD in AF recurrence after catheter ablation. OBJECTIVE We sought to investigate whether preexisting or new-onset IHD is associated with a greater risk of AF recurrence after ablation. METHODS With use of Danish nationwide registries, all patients undergoing first-time AF ablation in Denmark from 2010 to 2020 were identified. The primary outcome was AF recurrence defined by AF-related hospital admission or antiarrhythmic drug use within 1 year after ablation excluding a 3-month blanking period. IHD was defined as an International Classification of Diseases, Tenth Revision diagnosis of IHD or prior coronary revascularization. RESULTS Of 12,162 patients undergoing first-time ablation for AF (mean age, 62 years; 30% female), 20% had preexisting IHD. Preexisting IHD was associated with an increased risk of AF recurrence in univariable log-binomial logistic regression (relative risk, 1.09; 95% CI, 1.04-1.14; P < .001). However, after multivariable adjustment including procedural year, preexisting IHD was no longer associated with an increased risk of AF recurrence (relative risk, 1.02; 95% CI, 0.97-1.06; P = .42). In a nested case-control study of those without preexisting IHD before ablation (n = 9778), newly diagnosed IHD after ablation was associated with an increased risk of AF recurrence in multivariable analysis (hazard ratio, 3.03; 95% CI, 1.84-4.99; P < .001). CONCLUSION The presence of IHD does not appear to reduce the effectiveness of AF ablation procedures. However, the emergence of IHD after AF ablation may serve as a trigger for AF that is insufficiently suppressed by prior ablation.
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Daniel Modin
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kira Hyldekær Janstrup
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Kristian Eskesen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Allan Zeeberg Iversen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - René H Worck
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory M Marcus
- Department of Cardiology, University of California, San Francisco, California
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Steno Diabetes Center, Copenhagen, Denmark
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2
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La Rosa G, Morillo CA, Quintanilla JG, Doltra A, Mont L, Rodríguez-Mañero M, Sarkozy A, Merino JL, Vivas D, Datino T, Calvo D, Pérez-Castellano N, Pérez-Villacastín J, Fauchier L, Lip G, Hatem SN, Jalife J, Sanchis L, Marín F, Filgueiras-Rama D. Practical approach for atrial cardiomyopathy characterization in patients with atrial fibrillation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:656-666. [PMID: 38428580 DOI: 10.1016/j.rec.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
Atrial fibrillation (AF) causes progressive structural and electrical changes in the atria that can be summarized within the general concept of atrial remodeling. In parallel, other clinical characteristics and comorbidities may also affect atrial tissue properties and make the atria susceptible to AF initiation and its long-term persistence. Overall, pathological atrial changes lead to atrial cardiomyopathy with important implications for rhythm control. Although there is general agreement on the role of the atrial substrate for successful rhythm control in AF, the current classification oversimplifies clinical management. The classification uses temporal criteria and does not establish a well-defined strategy to characterize the individual-specific degree of atrial cardiomyopathy. Better characterization of atrial cardiomyopathy may improve the decision-making process on the most appropriate therapeutic option. We review current scientific evidence and propose a practical characterization of the atrial substrate based on 3 evaluation steps starting with a clinical evaluation (step 1), then assess outpatient complementary data (step 2), and finally include information from advanced diagnostic tools (step 3). The information from each of the steps or a combination thereof can be used to classify AF patients in 4 stages of atrial cardiomyopathy, which we also use to estimate the success on effective rhythm control.
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Affiliation(s)
- Giulio La Rosa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Carlos A Morillo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Adelina Doltra
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Lluis Mont
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología y Unidad Coronaria, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Andrea Sarkozy
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - José Luis Merino
- Departamento de Cardiología, Hospital Universitario La Paz, IDIPaz, Universidad Autónoma, Madrid, Spain
| | - David Vivas
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain
| | - Tomás Datino
- Departamento de Cardiología, Hospitales Universitarios Quirónsalud Pozuelo y Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
| | - David Calvo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain
| | - Nicasio Pérez-Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Julián Pérez-Villacastín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Laurent Fauchier
- Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Stéphane N Hatem
- Sorbonne Université, Foundation for Innovation in Cardiometabolism and Nutrition - ICAN, INSERM UMRS 1166, Institute of Cardiology, AP-HP Pitié-Salpêtrière Paris, France
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Laura Sanchis
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), El Palmar, Murcia, Spain.
| | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain.
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Mekhael M, Marrouche N, Hajjar AHE, Donnellan E. The relationship between atrial fibrillation and coronary artery disease: Understanding common denominators. Trends Cardiovasc Med 2024; 34:91-98. [PMID: 36182022 DOI: 10.1016/j.tcm.2022.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 01/04/2023]
Abstract
Atrial fibrillation (AF) and coronary artery disease (CAD) are highly prevalent cardiovascular conditions. The coexistence of both diseases is common as they share similar risk factors and common pathophysiological characteristics. Systemic inflammatory conditions are associated with an increased incidence of both AF and CAD. The presence of both entities increases the incidence of complications and adverse outcomes. Furthermore, their coexistence poses challenges for the management of patients, particularly with respect to anticoagulation and rhythm management. In this review, we aim to better understand the relationship between AF and CAD by detailing basic molecular pathophysiology, assessing therapeutic guidelines, and describing interactions between the two conditions.
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Affiliation(s)
- Mario Mekhael
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Eoin Donnellan
- Tulane University School of Medicine, New Orleans, LA, USA.
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4
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Shantsila E, Choi EK, Lane DA, Joung B, Lip GY. Atrial fibrillation: comorbidities, lifestyle, and patient factors. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100784. [PMID: 38362547 PMCID: PMC10866737 DOI: 10.1016/j.lanepe.2023.100784] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Modern anticoagulation therapy has dramatically reduced the risk of stroke and systemic thromboembolism in people with atrial fibrillation (AF). However, AF still impairs quality of life, increases the risk of stroke and heart failure, and is linked to cognitive impairment. There is also a recognition of the residual risk of thromboembolic complications despite anticoagulation. Hence, AF management is evolving towards a more comprehensive understanding of risk factors predisposing to the development of this arrhythmia, its' complications and interventions to mitigate the risk. This review summarises the recent advances in understanding of risk factors for incident AF and managing these risk factors. It includes a discussion of lifestyle, somatic, psychological, and socioeconomic risk factors. The available data call for a practice shift towards a more individualised approach considering an increasingly broader range of health and patient factors contributing to AF-related health burden. The review highlights the needs of people living with co-morbidities (especially with multimorbidity), polypharmacy and the role of the changing population demographics affecting the European region and globally.
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Affiliation(s)
- Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Brownlow Group GP Practice, Liverpool, United Kingdom
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
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5
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Cappello IA, Pannone L, Della Rocca DG, Sorgente A, Del Monte A, Mouram S, Vetta G, Kronenberger R, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, La Meir M, Belsack D, Sarkozy A, Brugada P, Tanaka K, Chierchia GB, Gharaviri A, de Asmundis C. Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes. Europace 2023; 25:euad328. [PMID: 38064697 PMCID: PMC10751806 DOI: 10.1093/europace/euad328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. METHODS AND RESULTS All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). CONCLUSION In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.
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Affiliation(s)
- Ida Anna Cappello
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Rani Kronenberger
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ali Gharaviri
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
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Oancea AF, Jigoranu RA, Morariu PC, Miftode RS, Trandabat BA, Iov DE, Cojocaru E, Costache II, Baroi LG, Timofte DV, Tanase DM, Floria M. Atrial Fibrillation and Chronic Coronary Ischemia: A Challenging Vicious Circle. Life (Basel) 2023; 13:1370. [PMID: 37374152 DOI: 10.3390/life13061370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Atrial fibrillation, the most frequent arrhythmia in clinical practice and chronic coronary syndrome, is one of the forms of coronary ischemia to have a strong dual relationship. Atrial fibrillation may accelerate atherosclerosis and may increase oxygen consumption in the myocardium, creating a mismatch between supply and demand, thus promoting the development or worsening of coronary ischemia. Chronic coronary syndrome alters the structure and function of gap junction proteins, affecting the conduction of action potential and leading to ischemic necrosis of cardiomyocytes and their replacement with fibrous tissue, in this way sustaining the focal ectopic activity in atrial myocardium. They have many risk factors in common, such as hypertension, obesity, type 2 diabetes mellitus, and dyslipidemia. It is vital for the prognosis of patients to break this vicious circle by controlling risk factors, drug therapies, of which antithrombotic therapy may sometimes be challenging in terms of prothrombotic and bleeding risk, and interventional therapies (revascularization and catheter ablation).
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Affiliation(s)
- Alexandru Florinel Oancea
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Raul Alexandru Jigoranu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Paula Cristina Morariu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Radu-Stefan Miftode
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Bogdan Andrei Trandabat
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Diana Elena Iov
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Department of Morphofunctional Sciences-Pathology, Pediatric Hospital, 700115 Iasi, Romania
| | - Irina Iuliana Costache
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Cardiology Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Livia Genoveva Baroi
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Surgery Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Daniel Vasile Timofte
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Surgery Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, 700115 Iasi, Romania
- Internal Medicine Clinic, St. Spiridon Emergency Hospital, 700115 Iasi, Romania
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7
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Satish M, Walters RW, Alla VM, Halperin JL. Association Between Stable Coronary Artery Disease and Hospital Readmissions Following Catheter Ablation for Atrial Fibrillation. Mayo Clin Proc 2023:S0025-6196(23)00014-9. [PMID: 37125976 DOI: 10.1016/j.mayocp.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/15/2022] [Accepted: 01/10/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To evaluate the association of stable coronary artery disease (CAD) with readmission following hospitalization for catheter ablation (CA) for atrial fibrillation (AF). PATIENTS AND METHODS Using the Nationwide Readmissions Database, we identified all hospitalizations from the last quarter of 2015 through 2019 with a Medicare Severity-Diagnosis Related Group designation for a percutaneous intracardiac procedure, a procedure code for CA, and a primary discharge diagnosis of AF. Cases of acute coronary syndrome (ACS) at index hospitalization were excluded to define stable CAD. The primary outcome was all-cause 90-day hospital readmission; secondary end points included readmissions for AF, repeated CA, ACS, and heart failure (HF). RESULTS Among 28,466 hospitalizations for CA for AF identified, 3171 (11.1%) involved patients with stable CAD. No hospitalizations included patients with HF diagnosis codes. The incidence of 90-day all-cause readmission was higher in patients with stable CAD (18.4% [400 of 2172] vs 14.4% [2549 of 17,667]; P=.006), as was the incidence of subsequent hospitalization with ACS (5.3% [21] vs 1.1% [28]; P<.001) or HF (17.0% [68] vs 10.2% [260]; P=.007). The incidence of readmission within 90 days with recurrent AF did not differ for those with or without stable CAD (21.9% [88] vs 26.5% [675]; P=.217). Pooled analysis of 90-day HF readmissions revealed a higher incidence among older patients, those with chronic kidney or pulmonary disease, and those with persistent and chronic AF subtypes. CONCLUSION Results of this large-scale analysis suggest that among patients hospitalized for CA for AF, stable CAD is associated with hospital readmissions within 90 days, including admissions for ACS and decompensated HF.
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Affiliation(s)
- Mohan Satish
- Icahn School of Medicine at Mount Sinai, New York, NY
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8
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Garcia R, Clouard M, Plank F, Degand B, Philibert S, Laurent G, Poupin P, Sakhy S, Gras M, Stühlinger M, Szegedi N, Herczeg S, Simon J, Crijns HJGM, Marijon E, Christiaens L, Guenancia C. Asymptomatic left circumflex artery stenosis is associated with higher arrhythmia recurrence after persistent atrial fibrillation ablation. Front Cardiovasc Med 2022; 9:873135. [PMID: 36225960 PMCID: PMC9548703 DOI: 10.3389/fcvm.2022.873135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background The pathophysiology of persistent atrial fibrillation (AF) remains unclear. While several studies have demonstrated an association between myocardial infarction and atrial fibrillation, the role of stable coronary artery disease (CAD) is still unknown. As a result, we aimed to assess the association between CAD obstruction and AF recurrence after persistent AF ablation in patients with no history of CAD. Materials and methods This observational retrospective study included consecutive patients who underwent routine preprocedural cardiac computed tomography (CCT) before persistent AF ablation between September 2015 and June 2018 in 5 European University Hospitals. Exclusion criteria were CAD or coronary revascularization previously known or during follow-up. Obstructive CAD was defined as luminal stenosis ≥ 50%. Results All in all, 496 patients (mean age 61.8 ± 10.0 years, 76.2% males) were included. CHA2DS2-VASc score was 0 or 1 in 225 (36.3%) patients. Obstructive CAD was present in 86 (17.4%) patients. During the follow-up (24 ± 19 months), 207 (41.7%) patients had AF recurrence. The recurrence rate was not different between patients with and without obstructive CAD (43.0% vs. 41.5%, respectively; P = 0.79). When considering the location of the stenosis, the recurrence rate was higher in the case of left circumflex obstruction: 56% vs. 32% at 2 years (log-rank P ≤ 0.01). After Cox multivariate analysis, circumflex artery obstruction (HR 2.32; 95% CI 1.36-3.98; P < 0.01) was independently associated with AF recurrence. Conclusion Circumflex artery obstruction detected with CCT was independently associated with 2-fold increase in the risk of AF recurrence after persistent AF ablation. Further research is necessary to evaluate this pathophysiological relationship.
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Affiliation(s)
- Rodrigue Garcia
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
- Centre d’Investigation Clinique 1402, University Hospital of Poitiers, Poitiers, France
| | - Mathilde Clouard
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
| | - Fabian Plank
- University Clinic of Internal Medicine III/Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bruno Degand
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
| | - Séverine Philibert
- Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | | | - Pierre Poupin
- Division of Geriatric Medicine, Tours University Hospital, Tours, France
| | - Saliman Sakhy
- Cardiology Department, University Hospital, Dijon, France
| | - Matthieu Gras
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
| | - Markus Stühlinger
- University Clinic of Internal Medicine III/Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Szilvia Herczeg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Judit Simon
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Harry J. G. M. Crijns
- School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Eloi Marijon
- Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Luc Christiaens
- Cardiology Department, University Hospital of Poitiers, Poitiers, France
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9
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Cui YK, Dong JZ, Du X, Hu R, He L, Long DY, Bai R, Yu RH, Sang CH, Jiang CX, Liu N, Li SN, Wang W, Guo XY, Zhao X, Zuo S, Tang RB, Ma CS. Outcome of catheter ablation for paroxysmal atrial fibrillation in patients with stable coronary artery disease. Pacing Clin Electrophysiol 2022; 45:1032-1041. [PMID: 35866663 DOI: 10.1111/pace.14571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 04/19/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
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, 12104 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 = 0.03). 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 = 0.04). 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 = 0.03). The composite secondary endpoints were significantly higher in the SCAD group (12.70% vs. 8.54%, P = 0.02), mainly due to thromboembolism events (8.16% vs. 4.41%, P<0.01). 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. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yi-Kai Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, No. 2 Beijing Anzhen Road, Chaoyang District, Beijing, 100029, China
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10
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Watanabe R, Nagashima K, Wakamatsu Y, Otsuka N, Yokoyama K, Matsumoto N, Otsuka T, Suzuki S, Hirata A, Murakami M, Takami M, Kimura M, Fukaya H, Nakahara S, Kato T, Hayashi H, Iwasaki YK, Shimizu W, Nakajima I, Harada T, Koyama J, Okumura K, Tokuda M, Yamane T, Tanimoto K, Momiyama Y, Nonoguchi N, Soejima K, Ejima K, Hagiwara N, Harada M, Sonoda K, Inoue M, Kumagai K, Hayashi H, Yazaki Y, Satomi K, Watari Y, Okumura Y. Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation. Circ J 2022; 86:233-242. [PMID: 34219078 DOI: 10.1253/circj.cj-21-0326] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear whether there are differences in the clinical factors between atrial fibrillation (AF) recurrence and adverse clinical events (AEs), including stroke/transient ischemic attack (TIA), major bleeding, and death, after AF ablation. METHODS AND RESULTS We examined the data from a retrospective multicenter Japanese registry conducted at 24 cardiovascular centers between 2011 and 2017. Of the 3,451 patients (74.1% men; 63.3±10.3 years) who underwent AF ablation, 1,046 (30.3%) had AF recurrence and 224 (6.5%) suffered AEs (51 strokes/TIAs, 71 major bleeding events, and 36 deaths) over a median follow-up of 20.7 months. After multivariate adjustment, female sex, persistent and long-lasting persistent AF (vs. paroxysmal AF), and stepwise increased left atrial diameter (LAd) quartiles were significantly associated with post-ablation recurrences. A multivariate analysis revealed that an age ≥75 years (vs. <65 years), body weight <50 kg, diabetes, vascular disease, left ventricular (LV) ejection fraction <40% (vs. ≥50%), Lad ≥44 mm (vs. <36 mm), and creatinine clearance <50 mL/min were independently associated with AE incidences, but not with recurrences. CONCLUSIONS This study disclosed different determinants of post-ablation recurrence and AEs. Female sex, persistent AF, and enlarged LAd were determinants of post-ablation recurrence, whereas an old age, comorbidities, and LV and renal dysfunction rather than post-ablation recurrence were AEs determinants. These findings will help determine ablation indications and post-ablation management.
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Affiliation(s)
- Ryuta Watanabe
- Division of Cardiology, Nihon University Itabashi Hospital
- Department of Cardiology, Nihon University Hospital
| | | | - Yuji Wakamatsu
- Division of Cardiology, Nihon University Itabashi Hospital
| | - Naoto Otsuka
- Division of Cardiology, Nihon University Itabashi Hospital
| | | | | | | | - Shinya Suzuki
- Department of Cardiology, The Cardiovascular Institute
| | - Akio Hirata
- Cardiovascular Division, Osaka Police Hospital
| | | | | | | | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | | | | | | | | | - Tomoo Harada
- St. Marianna University School of Medicine Hospital
| | | | | | | | - Teiichi Yamane
- Division of Cardiology, The Jikei University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | - Hidemori Hayashi
- Department of Cardiology, Juntendo University School of Medicine
| | | | | | - Yuji Watari
- Department of Cardiology, Teikyo University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Nihon University Itabashi Hospital
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11
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Chen X, Zhao J, Zhu K, Qin F, Liu H, Tao H. The Association Between Recurrence of Atrial Fibrillation and Revascularization in Patients With Coronary Artery Disease After Catheter Ablation. Front Cardiovasc Med 2021; 8:756552. [PMID: 34869668 PMCID: PMC8639697 DOI: 10.3389/fcvm.2021.756552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The connection between revascularization for coronary artery disease (CAD) and the incidence of recurrent events of atrial fibrillation (AF) after ablation is unclear. This study aimed to explore the relationship between coronary revascularization and AF recurrence in patients who underwent radiofrequency catheter ablation (RFCA). Methods: Four hundred and nineteen patients who underwent performed coronary angiography at the same time as RFCA were enrolled in this study. Obstructive CAD was defined as at least one coronary artery vessel stenosis of ≥75% and percutaneous coronary intervention (PCI) was recommended. Non-obstructive CAD was defined as coronary artery vessel stenosis of <75%. The endpoint was freedom from recurrence from AF after RFCA during the 24-month follow-up. Results: In total, 102, 95, and 212 patients were undergone coronary angiography and diagnosed as having obstructive CAD, Non-obstructive CAD, and Non-CAD, respectively. During the 24-month follow-up period, patients without obstructive CAD were significantly more likely to achieve freedom from AF than patients with obstructive CAD (hazard ratio [HR]: 1.72; 95% confidence interval [CI]: 1.23-2.41; P = 0.001). The recurrence rate of AF was significantly lower in patients who underwent PCI than in those who did not (HR: 0.45; 95% CI: 0.25-0.80; P = 0.007). The multivariate regression analysis showed that the other predictors of AF recurrence for obstructive CAD were multivessel stenosis (HR: 1.92; 95% CI: 1.04-3.54; P = 0.036) and left atrial diameter (HR: 2.56; 95% CI: 1.31-5.00; P = 0.006). Conclusions: This study suggests that obstructive CAD is associated with a higher rate of AF recurrence. Additionally, For patients with CAD, coronary revascularization is related to a lower recurrence rate of AF after RFCA.
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Affiliation(s)
- Xiaowei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiangtao Zhao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kui Zhu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fen Qin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hengdao Liu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hailong Tao
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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12
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Cui YK, Dong JZ, Du X, Hu R, He L, Jia CQ, Li X, Wu JH, Yu RH, Long DY, Ning M, Sang CH, Jiang CX, Bai R, Wen SN, Liu N, Li SN, Wang W, Guo XY, Zhao X, Zuo S, Chen X, Huang ST, Wu HS, Tang RB, Ma CS. Comparison of prognosis and outcomes of catheter ablation versus drug therapy in patients with atrial fibrillation and stable coronary artery disease: A prospective propensity-score matched cohort study. Clin Cardiol 2021; 44:1422-1431. [PMID: 34318505 PMCID: PMC8495083 DOI: 10.1002/clc.23699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/08/2022] Open
Abstract
Background Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist. Hypothesis To investigate the prognosis of catheter ablation versus drug therapy in patients with AF and SCAD. Methods In total, 25 512 patients with AF in the Chinese AF Registry between 2011 and 2019 were screened for SCAD. 815 patients with AF and SCAD underwent catheter ablation therapy were matched with patients by drug therapy in a 1:1 ratio. Primary end point was composite of thromboembolism, coronary events, major bleeding, and all‐cause death. The secondary endpoints were each component of the primary endpoint and AF recurrence. Results Over a median follow‐up of 45 ± 23 months, the patients in the catheter ablation group had a higher AF recurrence‐free rate (53.50% vs. 18.41%, p < .01). In multivariate analysis, there was no significant difference between the strategy of catheter ablation and drug therapy in primary composite end point (adjusted HR 074, 95%CI 0.54–1.002, p = .0519). However, catheter ablation was associated with fewer all‐cause death independently (adjusted HR 0.36, 95%CI 0.22–0.59, p < .01). In subgroup analysis, catheter ablation was an independent risk factor for all‐cause death in the high‐stroke risk group (adjusted HR 0.39, 95%CI 0.23–0.64, p < .01), not in the low‐medium risk group (adjusted HR 0.17, 95%CI 0.01–2.04, p = .17). Conclusions In the patients with AF and SCAD, catheter ablation was not independently associated with the primary composite endpoint compared with drug therapy. However, catheter ablation was an independent protective factor of all‐cause death
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Affiliation(s)
- Yi-Kai Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chang-Qi Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xu Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xuan Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Shu-Tao Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hao-Sheng Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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13
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Kornej J, Henger S, Seewöster T, Teren A, Burkhardt R, Thiele H, Thiery J, Scholz M. Prevalence of atrial fibrillation dependent on coronary artery status: Insights from the LIFE-Heart Study. Clin Cardiol 2020; 43:1616-1623. [PMID: 33107623 PMCID: PMC7724233 DOI: 10.1002/clc.23490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/07/2023] Open
Abstract
Background Coronary artery disease (CAD) is a significant risk factor for atrial fibrillation (AF). Experimental studies demonstrated that atrial ischemia induced by right coronary artery (RCA) stenosis promote AF triggers and development of electro‐anatomical substrate for AF. Aim To analyze the association between AF prevalence and coronary arteries status in the LIFE‐Heart Study. Methods This analysis included patients with available coronary catheterization data recruited between 2006 and 2014. Patients with acute myocardial infarction were excluded. CAD was defined as stenosis ≥75%, while coronary artery sclerosis (CAS) was defined as non‐critical plaque(s) <75%. Results In total, 3.458 patients (median age 63 years, 34% women) were included into analysis. AF was diagnosed in 238 (6.7%) patients. There were 681 (19.7%) patients with CAS and 1.411 (40.8%) with CAD (27.5% with single, 32.4% with double, and 40.1% with triple vessel CAD). In multivariable analysis, there was a significant association between prevalent AF and coronary artery status (OR 0.64, 95% CI 0.53‐0.78, Ptrend < .001). Similarly, AF risk was lower in patients with higher CAD extent (OR 0.54, 95%CI 0.35‐0.83, Ptrend = .005). Compared to single vessel CAD, the risk of AF was lower in double (OR 0.42, 95%CI 0.19‐0.95, P = .037) and triple CAD (OR 0.31, 95%CI 0.13‐0.71, P = .006). Finally, no association was found between AF prevalence and CAD origin among patients with single vessel CAD. Conclusion In the LIFE‐Heart Study, CAS but not CAD was associated with increased risk of AF.
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Affiliation(s)
- Jelena Kornej
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.,Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.,LIFE - Leipzig Research Center of Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Sylvia Henger
- LIFE - Leipzig Research Center of Civilization Diseases, Leipzig University, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
| | - Timm Seewöster
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Andrej Teren
- LIFE - Leipzig Research Center of Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Ralph Burkhardt
- LIFE - Leipzig Research Center of Civilization Diseases, Leipzig University, Leipzig, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center at University of Leipzig, Leipzig, Germany
| | - Joachim Thiery
- LIFE - Leipzig Research Center of Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Markus Scholz
- LIFE - Leipzig Research Center of Civilization Diseases, Leipzig University, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany
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14
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Liu L, Zhao D, Zhang J, Yang H, Abdu FA, Guo R, Li S, Tang K, Li H, Che W, Xu Y. Impact of Stable Coronary Artery Disease on the Efficacy of Cryoballoon Ablation for the Atrial Fibrillation. Am J Med Sci 2019; 358:204-211. [DOI: 10.1016/j.amjms.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/14/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
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15
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Hiraya D, Sato A, Hoshi T, Watabe H, Yoshida K, Komatsu Y, Sekiguchi Y, Nogami A, Ieda M, Aonuma K. Impact of coronary artery disease and revascularization on recurrence of atrial fibrillation after catheter ablation: Importance of ischemia in managing atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1491-1498. [DOI: 10.1111/jce.14029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Daigo Hiraya
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Akira Sato
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Tomoya Hoshi
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Hiroaki Watabe
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Kentaro Yoshida
- Cardiovascular DivisionIbaraki Prefectural Central HospitalKasama Ibaraki Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukuba Ibaraki Japan
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16
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Kircher S, Arya A, Altmann D, Rolf S, Bollmann A, Sommer P, Dagres N, Richter S, Breithardt OA, Dinov B, Husser D, Eitel C, Gaspar T, Piorkowski C, Hindricks G. Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study. Europace 2017; 20:1766-1775. [DOI: 10.1093/europace/eux310] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simon Kircher
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - David Altmann
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Ole-A Breithardt
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Charlotte Eitel
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Thomas Gaspar
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Christopher Piorkowski
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, University Leipzig—Heart Center, Struempellstrasse 39, Leipzig, Germany
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17
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Martin RIR, Bates MGD. Management of atrial fibrillation and concomitant coronary artery disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/cce2.55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- R. I. R. Martin
- Cardiothoracic Department; The James Cook University Hospital; Middlesbrough TS4 3BW U.K
| | - M. G. D. Bates
- Cardiothoracic Department; The James Cook University Hospital; Middlesbrough TS4 3BW U.K
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