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Updated: Nov 2, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
The relation between the atrial blood supply and the complexity of acute atrial fibrillation
Elton A M P Dudink1, Elham Bidar2,3, Judith Jacobs1
1Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
Insights
Age and extensive ventricular coronary artery disease, not atrial blood supply, predict atrial fibrillation complexity in patients without prior AF. This finding impacts understanding the link between heart conditions.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Myocardial infarction and coronary artery disease (CAD) increase atrial fibrillation (AF) risk.
- AF also elevates the risk of myocardial infarction, suggesting shared pathophysiology.
- Investigating the link between coronary angiographic parameters and AF substrate is crucial.
Purpose of the Study:
- To determine if coronary angiographic parameters are associated with AF substrate in patients without a history of AF.
- To assess the relationship between atrial coronary blood supply and AF complexity.
- To identify predictors of AF complexity in patients undergoing cardiac surgery.
Main Methods:
- Induced AF using burst pacing in 62 patients undergoing cardiac surgery without prior AF.
- Assessed preoperative coronary angiograms for CAD severity and atrial coronary blood supply using a novel scoring system.
- Utilized epicardial mapping of the right atrium to evaluate induced AF complexity.
Main Results:
- No association found between right atrial coronary blood supply adequacy and AF complexity.
- Increasing age was independently associated with increased maximal activation time difference (p=0.03).
- Presence of three-vessel disease (3VD) was independently associated with increased maximal activation time difference (p=0.04).
Conclusions:
- Epicardial right atrial blood supply adequacy does not correlate with increased AF complexity in patients without prior AF.
- Age and the extent of ventricular coronary artery disease are independent predictors of AF complexity.
- Findings suggest ventricular CAD and age, rather than atrial supply, influence AF substrate.
Background:
Patients with a history of myocardial infarction and coronary artery disease (CAD) have a higher risk of developing AF. Conversely, patients with atrial fibrillation (AF) have a higher risk of developing myocardial infarction, suggesting a link in underlying pathophysiology. The aim of this study was to assess whether coronary angiographic parameters are associated with a substrate for AF in patients without a history of AF.
Methods:
During cardiac surgery in 62 patients (coronary artery bypass grafting (CABG;n = 47), aortic valve replacement (AVR;n = 9) or CABG + AVR (n = 6)) without a history of clinical AF (age 65.4 ± 8.5 years, 26.2% female), AF was induced by burst pacing. The preoperative coronary angiogram (CAG) was assessed for the severity of CAD, and the adequacy of atrial coronary blood supply as quantified by a novel scoring system including the location and severity of right coronary artery disease in relation to the right atrial branches. Epicardial mapping of the right atrium (256 unipolar electrodes) was used to assess the complexity of induced AF.
Results:
There was no association between the adequacy of right atrial coronary blood supply on preoperative CAG and AF complexity parameters. Multivariable analysis revealed that only increasing age (B0.232 (0.030;0.433),p = 0.03) and the presence of 3VD (B3.602 (0.187;7.018),p = 0.04) were independently associated with an increased maximal activation time difference.
Conclusions:
The adequacy of epicardial right atrial blood supply is not associated with increased complexity of induced atrial fibrillation in patients without a history of clinical AF, while age and the extent of ventricular coronary artery disease are.
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