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Updated: Feb 25, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Outcomes of patients with periprocedural atrial fibrillation undergoing percutaneous coronary intervention for
Barbara E Stähli1, Cathérine Gebhard2, Michael Gick2
1Department of Cardiology, Charité Berlin, University Medicine, Campus Benjamin Franklin, Berlin, Germany.
Insights
Atrial fibrillation increases mortality risk after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). However, successful CTO PCI significantly improves survival for both atrial fibrillation and sinus rhythm patients.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) offers clinical benefits.
- Outcomes for patients with atrial fibrillation (AF) undergoing CTO PCI are not well-established.
Purpose of the Study:
- To investigate the association between atrial fibrillation and patient outcomes following CTO PCI.
- To compare mortality rates in patients with and without AF after CTO PCI.
Main Methods:
- A cohort of 2002 patients undergoing CTO PCI from 2005-2013 was analyzed.
- Patients were categorized into those with and without atrial fibrillation.
- Propensity-matched models were used to control for baseline differences, with all-cause mortality as the primary endpoint.
Main Results:
- Atrial fibrillation was present in 8.4% of patients and was associated with older age and comorbidities.
- Unmatched analysis showed higher mortality in AF patients (39.6% vs. 14.5%).
- Propensity-matched analysis confirmed AF independently associated with increased mortality risk (HR 1.62, p=0.03), yet successful CTO PCI reduced mortality in both AF and sinus rhythm groups.
Conclusions:
- Atrial fibrillation is an independent predictor of mortality post-CTO PCI.
- Successful CTO recanalization provides a significant survival advantage, irrespective of atrial fibrillation status.
Background:
Successful CTO recanalization has been associated with clinical benefit. Outcomes of patients with atrial fibrillation undergoing CTO PCI have not been investigated, yet.
Aims:
This study sought to evaluate the association between atrial fibrillation and outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO).
Methods:
Consecutive patients undergoing CTO PCI between January 2005 and December 2013 were divided into patients with and without atrial fibrillation, and propensity-matched models used to adjust for baseline differences between groups. The primary outcome was all-cause mortality at a median follow-up of 3.2 (interquartile range 3.1-4.5) years.
Results:
Of 2002 patients undergoing CTO PCI, atrial fibrillation was present in 169 (8.4%) patients. Patients with atrial fibrillation were older, and more frequently had hypertension, left ventricular systolic dysfunction, and chronic kidney disease. Before matching, all-cause mortality was 39.6 and 14.5% in the atrial fibrillation and the sinus rhythm groups (HR 2.92, 95% CI 2.23-3.82, p < 0.001). In the propensity-matched model, atrial fibrillation remained associated with an increased risk of mortality (HR 1.62, 95% CI 1.06-2.47, p = 0.03). In the unmatched patient cohort, all-cause mortality was significantly reduced in patients with procedural success, both in the atrial fibrillation (34.9 versus 55.0%, adjusted HR 0.99, 95% CI 0.97-1.00, p = 0.02) and the sinus rhythm groups (12.8 versus 23.0%, adjusted HR 0.70, 95% CI 0.53-0.92, p = 0.01).
Conclusions:
Although atrial fibrillation is independently associated with mortality after CTO PCI, substantial survival benefit of successful CTO recanalization is observed in both patients with and without atrial fibrillation.
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