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Invasive Coronary Physiology Assessment in Patients With Arrhythmia-Induced Cardiomyopathy

Alice Benedetti1, Adriaan Wilgenhof1, Gianluca Castaldi1

  • 1Hartcentrum, Ziekenhuis Aan de Stroom (ZAS), Antwerp, Belgium.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 25, 2025
PubMed

Insights

Coronary microvascular dysfunction (CMD) is strongly linked to arrhythmia-induced cardiomyopathy (AIC) in atrial fibrillation (AF) patients. This dysfunction is an independent predictor of impaired left ventricular function in AF.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Internal Medicine

Background:

  • Arrhythmia-induced cardiomyopathy (AIC) results from impaired left ventricular function caused by cardiac arrhythmias.
  • Atrial fibrillation (AF) is a common arrhythmia that can lead to AIC.
  • Coronary microvascular dysfunction (CMD) is a potential contributor to AIC, but its association with AF requires further investigation.

Purpose of the Study:

  • To investigate the association between coronary microvascular dysfunction (CMD) and arrhythmia-induced cardiomyopathy (AIC) in patients with atrial fibrillation (AF).
  • To determine if CMD is an independent predictor of impaired left ventricular function in patients with AF.

Main Methods:

  • A multicenter observational study enrolled patients with recent AF diagnosis (<6 months).
  • Invasive coronary physiology assessment using bolus thermodilution was performed.
  • Patients were categorized by left ventricular ejection fraction (LVEF): AIC group (LVEF < 50%) and preserved LVEF group (LVEF ≥ 50%). A control group with dilated cardiomyopathy (DCM) without AF was also included.
  • CMD was defined by abnormal coronary flow reserve (CFR < 2.5) and/or abnormal index of microcirculatory resistance (IMR ≥ 25).

Main Results:

  • Among 84 patients, CMD was more prevalent in the AIC group (79%) compared to the preserved LVEF (38%) and DCM (33%) groups.
  • Significant correlations were observed between CFR and LVEF, and IMR and LVEF in AF patients.
  • Multivariable analysis revealed CMD as an independent predictor of AIC (adjusted odds ratio: 6.2).

Conclusions:

  • Coronary microvascular dysfunction (CMD) is strongly and independently associated with left ventricular dysfunction in patients with atrial fibrillation (AF).
  • CMD may play a significant role in the development of arrhythmia-induced cardiomyopathy (AIC) in the context of AF.
Abstract

Keywords:
arrhythmia‐induced cardiomyopathyatrial fibrillationcoronary flow reservecoronary microvascular dysfunctionindex of microcirculatory resistance

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