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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Evaluation of coronary artery disease in patients undergoing atrial fibrillation ablation: a non-invasive FFR
Shuichiro Kazawa1, Carlo de Asmundis1, Maysam Al Housari1
1Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, UZ Brussel-VUB, 101 Laarbeeklaan, 1090, Brussels, Belgium.
Insights
Computed tomography coronary angiography (CTCA) derived fractional flow reserve (FFR-CT) is feasible for evaluating coronary artery disease (CAD) in patients with atrial fibrillation (AF). This study found no significant difference in CAD rates or FFR-CT feasibility between AF and non-AF groups.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Atrial fibrillation (AF) is a common arrhythmia often associated with cardiovascular disease.
- Coronary artery disease (CAD) is a significant comorbidity in patients with AF.
- Fractional flow reserve derived from computed tomography coronary angiography (FFR-CT) is a non-invasive method to assess the functional significance of coronary stenoses.
Purpose of the Study:
- To evaluate the feasibility and diagnostic performance of FFR-CT in patients with AF undergoing ablation.
- To compare the prevalence and severity of CAD in patients with AF versus a control group without AF.
- To determine if AF rhythm affects the accuracy or success rate of FFR-CT analysis.
Main Methods:
- A retrospective study comparing 151 patients with AF undergoing CTCA before ablation (AF group) to 151 matched controls without AF (non-AF group).
- CTCA was performed, and coronary lesions were categorized by severity (mild, moderate, severe).
- FFR-CT was calculated for lesions with ≥50% luminal narrowing; feasibility and results (FFR-CT ≤ 0.80 indicating significant stenosis) were analyzed.
Main Results:
- CTCA was technically feasible in all patients, including those with AF as the presenting rhythm (38% of AF group).
- FFR-CT analysis was feasible in 73% of patients, with similar failure rates between AF and non-AF groups (27% vs 27%, P=0.74).
- No significant differences were found in the prevalence of severe, moderate, or mild stenosis, nor in the rate of hemodynamically significant stenosis (FFR-CT ≤ 0.80) between the groups.
Conclusions:
- CTCA is technically feasible for assessing CAD in patients with AF, even during an active arrhythmia.
- FFR-CT analysis is equally feasible in patients with and without AF, suggesting it is a reliable tool in this population.
- The similar prevalence of CAD in both groups supports the concept of shared risk factors for AF and CAD.
Abstract:
To evaluate coronary artery disease (CAD) with computed tomography coronary angiography (CTCA)-derived fractional flow reserve (FFR) in patients with atrial fibrillation (AF) requiring ablation. The study population consisted of 151 patients who underwent CTCA before AF ablation (AF group), and a control group of 151 patients from the outpatient clinic who underwent CTCA without any history of AF (non-AF group), matched for age, sex, BMI, and angina symptomatology. All study patients underwent CTCA with subdivision of coronary lesion type into severe (≥ 70% luminal narrowing), moderate (50% ≤ luminal narrowing < 70%), and mild stenosis (< 50% luminal narrowing). In patients with ≥ 1 moderate or severe stenosis, non-invasive FFR was calculated from CTCA (FFRCT). Baseline characteristics and CAD risk factors were similar between the 2 groups. During CTCA, 38% of the patients in the AF group were in ongoing atrial arrhythmia (either AF or regular atrial tachycardia). The number of patients with severe (10 (6.6%) vs 10 (6.6%), P = 1.00), moderate (14 (9.5%) vs 10 (6.7%), P = 0.4), and mild stenosis (43 (28.5%) vs 56 (37.1%), P = 0.11) was not significantly different between the 2 groups. Performance of FFRCT was feasible in 32/44 patients (73%), and failed in 27% of the patients (7 and 5 patients in the AF and non-AF group, respectively, P = 0.74). No difference was observed in the prevalence of hemodynamically significant stenosis (FFRCT ≤ 0.80) (15 (9.9%) vs 12 (7.9%), P = 0.85). Our study showed technical feasibility of CTCA in all patients of both groups, including the patients with AF as presenting rhythm. The FFRCT add-on analysis failed equally frequent in patients of the AF versus non-AF group. An equal rate of CAD was observed in the AF group and non-AF group, favoring the concept of shared associated risk factors for CAD and AF.
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