Evaluation of coronary artery disease in patients undergoing atrial fibrillation ablation: a non-invasive FFR computed tomography study

Shuichiro Kazawa; Carlo de Asmundis; Maysam Al Housari; Gezim Bala; Juan Sieira; Dries Belsack; Johan De Mey; Stijn Lochy; Bert Vandeloo; Jean-François Argacha; Pedro Brugada; Gian-Battista Chierchia; Kaoru Tanaka; Erwin Ströker

doi:10.1007/s00380-022-02226-5

Evaluation of coronary artery disease in patients undergoing atrial fibrillation ablation: a non-invasive FFR computed tomography study

Heart Vessels. 2023 Jun;38(6):757-763. doi: 10.1007/s00380-022-02226-5. Epub 2023 Jan 6.

Affiliations

¹ Heart 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.
² Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
³ Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
⁴ Heart 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. erwin.stroker@uzbrussel.be.

^# Contributed equally.

PMID: 36607386
DOI: 10.1007/s00380-022-02226-5

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 (FFR_CT). 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 FFR_CT 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 (FFR_CT ≤ 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 FFR_CT 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.

Keywords: Atrial fibrillation; Coronary artery disease; Fractional flow reserve computed from coronary computed tomographic angiograms.

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / surgery
Computed Tomography Angiography / methods
Constriction, Pathologic
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / surgery
Coronary Stenosis* / diagnostic imaging
Coronary Stenosis* / surgery
Coronary Vessels
Fractional Flow Reserve, Myocardial*
Humans
Predictive Value of Tests
Tomography, X-Ray Computed / methods