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Asymptomatic left circumflex artery stenosis is associated with higher arrhythmia recurrence after persistent atrial

Rodrigue Garcia1,2, Mathilde Clouard1, Fabian Plank3

  • 1Cardiology Department, University Hospital of Poitiers, Poitiers, France.

Frontiers in Cardiovascular Medicine
|October 13, 2022
PubMed

Insights

Coronary artery disease obstruction, specifically in the circumflex artery, increases the risk of atrial fibrillation recurrence after ablation. This finding highlights the importance of assessing coronary artery disease in patients undergoing atrial fibrillation ablation.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • The role of stable coronary artery disease (CAD) in persistent atrial fibrillation (AF) pathophysiology is not well understood.
  • Previous studies have linked myocardial infarction to AF, but the impact of obstructive CAD requires further investigation.

Purpose of the Study:

  • To investigate the association between obstructive coronary artery disease (CAD) and the recurrence of atrial fibrillation (AF) after ablation in patients without a prior history of CAD.
  • To determine if specific locations of CAD obstruction influence AF recurrence rates post-ablation.

Main Methods:

  • Retrospective observational study of 496 patients undergoing persistent AF ablation with preprocedural cardiac computed tomography (CCT).
  • Obstructive CAD defined as ≥ 50% luminal stenosis; patients with known CAD or revascularization were excluded.
  • Follow-up averaged 24 months to assess AF recurrence.

Main Results:

  • Obstructive CAD was present in 17.4% of patients; overall AF recurrence was 41.7%.
  • No significant difference in AF recurrence was observed between patients with and without obstructive CAD (43.0% vs. 41.5%, P=0.79).
  • Left circumflex artery obstruction was associated with a higher recurrence rate (56% vs. 32% at 2 years, P≤0.01) and independently predicted recurrence (HR 2.32, P<0.01).

Conclusions:

  • Obstruction in the circumflex artery, identified by CCT, independently doubles the risk of AF recurrence post-ablation.
  • This finding suggests a potential pathophysiological link between circumflex artery stenosis and AF recurrence.
  • Further research is warranted to elucidate the relationship between circumflex artery obstruction and AF recurrence.
Abstract

Keywords:
ablationatrial fibrillationcardiac computed tomography (CCT)coronary artery diseaseelectrophysiologypathophysiologypulmonary vein isolation (PVI)

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