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Atrial fibrillation and coronary microvascular dysfunction-A clinical signal
Haytham Abu Katash1, Lior Zornitzki1, Ophir Freund2
1Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University School of Medicine, Tel Aviv, Israel.
International Journal of Cardiology
|July 29, 2026
Summary
Atrial fibrillation (AF) is independently linked to coronary microvascular dysfunction (CMD). Patients with CMD show a higher prevalence of persistent or permanent AF, suggesting a complex relationship.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Coronary microvascular dysfunction (CMD) is a recognized cause of angina, even without epicardial coronary artery disease.
- A link between CMD and atrial fibrillation (AF) is emerging, but invasive microvascular assessment data is limited.
Purpose of the Study:
- To investigate the association between invasive measures of coronary microvascular function and the presence of atrial fibrillation.
- To determine if AF is independently associated with CMD.
Main Methods:
- Retrospective analysis of prospectively collected data from patients undergoing invasive coronary angiography and microvascular assessment (FFR, CFR, IMR, RRR).
- CMD defined by abnormal CFR, IMR, or RRR. AF defined by documented history.
- Multivariable analysis to assess independent associations.
Main Results:
- Coronary microvascular dysfunction (CMD) was present in 52% of patients.
- Atrial fibrillation (AF) was more prevalent in patients with CMD (13% vs. 6%).
- AF was independently associated with CMD (adjusted OR 2.19, p=0.031), with higher rates of persistent/permanent AF in CMD patients.
Conclusions:
- Atrial fibrillation (AF) is independently associated with coronary microvascular dysfunction (CMD).
- Persistent or permanent AF is more common in patients with CMD.
- Findings suggest a bidirectional relationship requiring further prospective research.
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