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Atrial fibrillation in coronary artery disease
S Lokshyn1, C Mewis, V Kuhlkamp
1Department of Cardiology, University Hospital Tübingen, Germany. lokshin@diag.vidr.dp.ua
Insights
In patients with coronary artery disease, atrial fibrillation is not primarily caused by atrial ischemia. Systolic heart failure is a more significant factor in the development of atrial fibrillation in this population.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Atrial fibrillation (AF) is a common arrhythmia, particularly in patients with coronary artery disease (CAD).
- The role of atrial ischemia in AF genesis among CAD patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between atrial ischemia and the occurrence of atrial fibrillation in patients with coronary artery disease.
- To identify other potential contributing factors to atrial fibrillation in this patient cohort.
Main Methods:
- Retrospective analysis of electrocardiograms and angiograms from 3220 consecutive patients undergoing coronary angiography.
- Comparison of coronary artery injury patterns and clinical characteristics between patients with and without atrial fibrillation.
Main Results:
- Atrial fibrillation was present in 2.3% of patients; 66.2% of these had significant coronary artery disease.
- No significant differences in the location or frequency of coronary artery injury were observed between AF and sinus rhythm groups.
- Patients with AF showed significantly higher rates of heart failure (55.1% vs. 18.5%), three-vessel disease (30.5% vs. 20.4%), and mitral valve insufficiency (20.4% vs. 10.2%).
Conclusions:
- Atrial ischemia does not appear to be the primary driver of atrial fibrillation in patients with coronary artery disease.
- Systolic heart failure is a more significant predictor of atrial fibrillation in patients with coronary artery disease compared to atrial ischemia.
Abstract:
To answer whether atrial ischemia plays an important role in the genesis of atrial fibrillation in patients with coronary artery disease, we analyzed the electrocardiograms obtained at the time of coronary angiography and left ventriculography in 3220 consecutive patients. Atrial fibrillation was found in 74 (2.3%). Among those with significant coronary artery disease were 49 (66.2%) patients with atrial fibrillation and 88.5% with sinus rhythm (P<0.02). Angiograms of patients with atrial fibrillation and significant (>50%) coronary stenosis were re-evaluated and results compared to the control group which consisted of 108 consecutive patients who were in sinus rhythm at the time of coronary angiography. There were no differences between groups with respect to either frequency of injury to the right coronary artery and circumflex branch of left coronary artery or localization of the injury to this region (before or after atrial branch take-off). But patients with atrial fibrillation significantly more often had heart failure (55.1% versus 18.5%, P<0.001) and three vessel disease (30.5% versus 20.4%, P=0.05) as well as mitral valve insufficiency (20.4% versus 10.2%, P<0.05). In conclusion, in patients with coronary disease, systolic heart failure may be more important than atrial ischemia in causing atrial fibrillation.