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Updated: Oct 8, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Atrial branch coronary artery stenosis as a mechanism for atrial fibrillation
Sean D Pokorney1, Samuel I Berchuck2, Karen Chiswell2
1Division of Cardiology, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Insights
Coronary artery disease (CAD) in atrial arteries increases atrial fibrillation (AF) risk. Stenosis in the right intermediate atrial artery and atrioventricular nodal artery are linked to new-onset AF.
Area of Science:
- Cardiology
- Electrophysiology
- Vascular Biology
Background:
- Atrial fibrillation (AF) etiology is complex and not fully understood.
- Coronary artery disease (CAD) is a common comorbidity in patients with AF.
Purpose of the Study:
- To investigate the association between CAD affecting atrial tissue and the development of new-onset AF.
- To quantify the impact of coronary stenosis severity in specific atrial arteries on AF risk.
Main Methods:
- A matched case-control study included patients with obstructive CAD undergoing cardiac catheterization.
- Quantitative stenosis severity was measured in sinoatrial nodal, AV nodal, and RIAA arteries.
- Multivariable logistic regression identified factors associated with new-onset AF within 12 months.
Main Results:
- Of 1794 patients, 6% developed AF within one year.
- Increased stenosis severity in the RIAA and AV nodal artery correlated with higher AF odds.
- A higher number of affected atrial arteries increased the likelihood of AF diagnosis.
Conclusions:
- Obstructive CAD in the AV nodal artery and RIAA is associated with increased odds of new-onset AF.
- A greater burden of CAD in atrial arteries elevates the risk of developing AF.
- These findings highlight the role of atrial coronary microvascular dysfunction in AF pathogenesis.
Background:
The etiology of atrial fibrillation (AF) is multifactorial and incompletely understood.
Objective:
The purpose of this study was to evaluate the association between coronary artery disease (CAD) affecting atrial tissue and AF.
Methods:
Patients from a single center with obstructive CAD during cardiac catheterization (January 1, 2007, through December 1, 2013) were included in a matched case-control analysis on the basis of the presence or absence of new-onset AF within 12 months of catheterization. Quantitative measurements of stenosis severity were performed for the sinoatrial nodal artery, atrioventricular (AV) nodal artery, and right intermediate atrial artery (RIAA) as well as the right coronary, left circumflex, and left anterior descending proximal to the takeoff for each atrial level artery. A multivariable logistic regression model identified factors associated with AF.
Results:
Of 1794 patients, 115 (6%) developed AF within 1 year of catheterization. The matched cohort included 110 patients with and 110 patients without AF within 12 months of catheterization. Higher odds of AF at 1 year were associated with increasing lesion stenosis severity in the RIAA (odds ratio [OR] 1.41 per 10% increase in lesion severity above 50%; 95% confidence interval [CI] 1.01-1.97; P = .047) and AV nodal artery (OR 1.58 per 10% increase in lesion severity above 50%; 95% CI 1.00-2.49; P = .050). Odds of AF diagnosis during the year after catheterization increased with the number of atrial arteries with >50% lesion (OR 1.53 for each additional artery; 95% CI 1.08-2.15; P = .015).
Conclusion:
In patients with obstructive CAD, disease of the AV nodal artery and RIAA as well as a higher burden of CAD within all arteries supplying blood flow to the atrial myocardium were associated with higher odds of new-onset AF at 1 year.
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