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Updated: Jul 10, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Atrial fibrillation and chronic total occlusion percutaneous coronary intervention outcomes: insights from the
Michaella Alexandrou1, Athanasios Rempakos1, Spyridon Kostantinis1
1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Atrial fibrillation patients undergoing chronic total occlusion PCI have more complex cases and longer procedures. While in-hospital outcomes are similar, follow-up MACE is higher but not independently linked to atrial fibrillation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia impacting cardiovascular health.
- Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is a complex procedure.
- The influence of AF on CTO PCI outcomes requires detailed investigation.
Purpose of the Study:
- To evaluate the impact of atrial fibrillation on the outcomes of chronic total occlusion percutaneous coronary intervention.
- To compare baseline characteristics, procedural results, and follow-up events between patients with and without atrial fibrillation undergoing CTO PCI.
Main Methods:
- A retrospective analysis of 9,166 CTO PCIs from 39 centers (2012-2023).
- Comparison of patient demographics, comorbidities, lesion characteristics, and procedural data.
- Assessment of in-hospital and follow-up Major Adverse Cardiovascular Events (MACE), including mortality.
Main Results:
- 12% of patients had atrial fibrillation; they were older with more comorbidities and complex CTO lesions.
- Patients with AF experienced longer procedure and fluoroscopy times.
- Technical success and in-hospital MACE were similar; however, crude follow-up MACE was higher in AF patients.
Conclusions:
- Atrial fibrillation patients undergoing CTO PCI present with higher complexity and longer procedural times.
- Despite similar in-hospital outcomes, AF patients show higher crude follow-up MACE.
- AF was not an independent predictor of adverse events on multivariate analysis.
Background:
We examined the effect of atrial fibrillation on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods:
We examined the baseline characteristics and procedural outcomes of 9,166 CTO PCIs performed at 39 US and non-US centers between 2012 and 2023.
Results:
Atrial fibrillation was present in 1122 (12%) patients. These patients were older and had a higher incidence of comorbidities, such as hypertension, dyslipidemia, heart failure, cerebrovascular disease, and peripheral arterial disease, lower left ventricular ejection fraction, and lower eGFR. Their CTOs were more likely to have moderate to severe calcification and longer lesion length. They also had higher mean J-CTO and PROGRESS-CTO complications (Acute MI, MACE, Mortality, Perforation, and Pericardiocentesis) scores. Patients with atrial fibrillation had higher prevalence of uncrossable and undilatable CTO lesions and required longer procedure (107 vs 119 min; P less than .001) and fluoroscopy (40 vs 43 min; P=.005) time. Technical success and MACE, including procedural/in-hospital bleeding, were similar in patients with and without atrial fibrillation. Although the crude incidence of MACE on follow-up (median 61 days) was significantly higher in patients with atrial fibrillation, the latter was not independently associated with adverse events on Cox proportional hazards analysis.
Conclusions:
Patients with atrial fibrillation undergoing CTO PCI are older, have more comorbidities, higher lesion complexity, and longer procedure time, but similar technical success and in-hospital MACE. They have higher MACE and mortality during follow-up, but the difference is not significant after adjusting for potential confounding variables.
