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When Atrial Fibrillation Co-Exists with Coronary Artery Disease in Patients with Prior Coronary Intervention - Does
Eric Chong1, Hung-Yu Chang2, Yun-Yu Chen3
1Division of Cardiology, Jurong General Hospital, Singapore; Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Insights
Catheter ablation significantly reduced major adverse cardiac events in patients with atrial fibrillation and coronary artery disease compared to medical therapy alone. This includes fewer strokes and acute coronary syndromes, improving patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Atrial fibrillation (AF) increases coronary artery disease (CAD) risk via inflammation and endothelial dysfunction.
- The benefit of AF catheter ablation on reducing adverse cardiac events in patients with established CAD is not well-defined.
- This study investigates if AF ablation and maintaining sinus rhythm reduce future cardiac events in CAD patients.
Purpose of the Study:
- To evaluate the efficacy of catheter ablation for AF in reducing major adverse cardiac events (MACE) in patients with prior percutaneous coronary intervention (PCI).
- To compare outcomes between patients with paroxysmal AF and CAD undergoing AF ablation versus medical management.
Main Methods:
- Retrospective case-control study of 310 patients with drug-refractory paroxysmal AF and prior PCI for CAD.
- 155 patients underwent AF catheter ablation; 155 received medical treatment.
- Follow-up for major adverse cardiac events (MACE), including acute coronary syndrome, stroke, pulmonary embolism, and mortality.
Main Results:
- The ablation group showed significantly lower all-cause mortality (1.3% vs 8.4%) and MACE (12.3% vs 47.7%) compared to the medical group over 61 months.
- AF ablation was associated with fewer strokes (3.2% vs 10.3%) and hospitalizations for acute coronary syndrome (7.1% vs 29%).
- Multivariate analysis identified non-ablation as an independent risk factor for MACE (HR 3.4, p<0.001).
Conclusions:
- Catheter ablation for AF in patients with established CAD and prior PCI leads to significantly fewer major adverse cardiac events compared to medical therapy.
- AF ablation is an effective strategy to reduce cardiovascular events in this high-risk patient population.
- Maintaining sinus rhythm through ablation improves outcomes for patients with both AF and CAD.
Background:
Atrial fibrillation (AF) can be associated with an increased risk of developing coronary artery disease (CAD) due to mechanisms of inflammation, endothelial dysfunction and adverse atrial remodelling. It is unclear if adverse coronary events can be further reduced after successful catheter ablation of AF. We hypothesise that AF ablation and sinus maintenance could reduce future adverse cardiac events in patients with underlying CAD.
Methods:
A total of 310 patients with drug-refractory paroxysmal AF and prior history of percutaneous coronary intervention (PCI) for underlying CAD were recruited in the retrospective case control study. Of these, 155 patients underwent AF ablation (the Ablation Group), while 155 patients received medical treatment (the Medical Group). All patients were followed up for major adverse cardiac events, including acute coronary syndrome requiring hospitalisation, stroke, pulmonary embolism and mortality.
Results:
The clinical characteristics were comparable between the two groups, except for higher antiarrhythmic drug use in the Medical Group. During a follow-up duration of 61±32 months, all-cause mortality (8.4% vs. 1.3%, p=0.004) and the overall major adverse events (47.7% vs. 12.3%, p<0.001) were significantly higher in the Medical Group than the Ablation Group. There were also more instances of stroke (10.3% vs. 3.2%, p=0.013) and acute coronary syndrome requiring hospitalisation (29% vs. 7.1%, p<0.001) in the Medical Group than the Ablation Group. Multivariate analysis confirmed that non-ablation was an independent risk factor for major adverse events (p<0.001, HR 3.4, 95% confidence interval 1.9-5.9).
Conclusion:
In PAF patients with established CAD who underwent PCI, catheter ablation could lead to fewer major adverse cardiac events compared to medical therapy.
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