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

• Published in: Heart and vessels Vol. 38; no. 6; pp. 757 - 763
• Main Authors: Kazawa, Shuichiro, de Asmundis, Carlo, Al Housari, Maysam, Bala, Gezim, Sieira, Juan, Belsack, Dries, De Mey, Johan, Lochy, Stijn, Vandeloo, Bert, Argacha, Jean-François, Brugada, Pedro, Chierchia, Gian-Battista, Tanaka, Kaoru, Ströker, Erwin
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.06.2023; Springer Nature B.V
• Subjects: Ablation; Angina; Angiography; Arrhythmia; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cardiovascular disease; Computed tomography; Computed Tomography Angiography - methods; Constriction, Pathologic; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - surgery; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - surgery; Coronary Vessels; Feasibility studies; Fibrillation; Fractional Flow Reserve, Myocardial; Heart diseases; Humans; Medicine; Medicine & Public Health; Original Article; Population studies; Predictive Value of Tests; Risk factors; Stenosis; Tachycardia; Technology assessment; Tomography; Tomography, X-Ray Computed - methods; Vascular Surgery; Vein & artery diseases; Fractional flow reserve computed from coronary computed tomographic angiograms; Coronary artery disease; Atrial fibrillation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-022-02226-5

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.