Impact of Coronary Artery Disease on The Outcomes of Catheter Ablation in Patients with Atrial Fibrillation

ABSTRACT Introduction: The objective of this study is to investigate the possible impact of coronary artery disease (CAD) on clinical outcomes of catheter ablation in patients with atrial fibrillation (AF). Methods: Patients with AF who underwent coronary computed tomography and catheter ablation were enrolled. The presence of stenotic severity and plaque, characteristics of coronary arteries, clinical data, and adverse outcomes of catheter ablation were analysed. Results: A total of 243 patients were enrolled, 100 (41%) patients with CAD. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, and sex category) score of AF patients with CAD was significantly (P<0.001) higher than of those without CAD. Presence of stenotic artery and plaques increased significantly with increase of CHA2DS2-VASc score (P<0.05). There was no significant (P=0.342) difference in AF recurrence between patients with and without CAD (30% versus 24%). Age, AF type, duration of AF, heart failure, CHA2DS2-VASc score, left ventricular ejection fraction, and left atrial diameter were significantly (P<0.05) correlated with AF recurrence in univariant analysis. Multivariable analysis revealed that duration of AF (hazard ratio [HR] 1.769), heart failure (HR 1.821), and left atrial diameter (HR 1.487, P=0.022) remained significant independent predictors of AF recurrence. Patients with AF and concomitant CAD were significantly (P=0.030) associated with a worse outcome. Conclusion: CAD concomitant with AF may be associated with a worse clinical outcome even though CAD does not significantly affect the risk of AF recurrence after ablation therapy.

摘要
引言：本研究旨在探讨冠状动脉疾病（coronary artery disease, CAD）对心房颤动（atrial fibrillation, AF）患者接受导管消融治疗的临床结局的潜在影响。
方法：纳入接受冠状动脉计算机断层扫描（coronary computed tomography）及导管消融治疗的心房颤动患者，对冠状动脉狭窄程度与斑块存在情况、冠状动脉特征、临床资料以及导管消融术后不良结局进行分析。
结果：本研究共纳入243例患者，其中100例（41%）合并冠状动脉疾病。合并冠状动脉疾病的心房颤动患者的CHA₂DS₂-VASc评分（涵盖充血性心力衰竭、高血压、年龄≥75岁、糖尿病、卒中或短暂性脑缺血发作、血管疾病、年龄65~74岁及性别类别）显著高于无冠状动脉疾病的患者（P<0.001）。随着CHA₂DS₂-VASc评分升高，冠状动脉狭窄及斑块的检出率显著上升（P<0.05）。合并与未合并冠状动脉疾病的患者的心房颤动复发率无显著差异（30% vs 24%，P=0.342）。单因素分析显示，年龄、心房颤动类型、心房颤动病程、心力衰竭、CHA₂DS₂-VASc评分、左心室射血分数以及左心房直径均与心房颤动复发显著相关（P<0.05）。多因素分析结果表明，心房颤动病程（风险比[HR] 1.769）、心力衰竭（HR 1.821）及左心房直径（HR 1.487，P=0.022）仍是心房颤动复发的独立显著预测因素。合并冠状动脉疾病的心房颤动患者的临床结局显著更差（P=0.030）。
结论：尽管冠状动脉疾病并未显著影响导管消融术后心房颤动复发的风险，但合并冠状动脉疾病的心房颤动患者仍可能出现更差的临床结局。