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

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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 (FFRCT). 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 FFRCT 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 (FFRCT ≤ 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 FFRCT 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.

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Author notes

  1. Kaoru Tanaka and Erwin Ströker have contributed equally as senior authors.

Authors and 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

    Shuichiro Kazawa, Carlo de Asmundis, Maysam Al Housari, Gezim Bala, Juan Sieira, Pedro Brugada, Gian-Battista Chierchia & Erwin Ströker

  2. Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium

    Stijn Lochy, Bert Vandeloo & Jean-François Argacha

  3. Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium

    Dries Belsack, Johan De Mey & Kaoru Tanaka

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  1. Shuichiro Kazawa
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  2. Carlo de Asmundis
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Correspondence to Erwin Ströker.

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Conflict of interest

C.d.A. reports speaker fees for Medtronic, Biotronik, Biosense Webster, Abbott and Boston Scientific; teaching honoraria from Medtronic, Biotronik, Abbott and Boston Scientific; proctoring honoraria from Medtronic, Abbott and Biotronik; G.B.C. reports speaker fees for Medtronic, Biotronik, Biosense Webster and Abbott; teaching honoraria from Medtronic and Biotronik; proctoring honoraria from Medtronic; P.B. reports consulting fees and speaker honoraria from Medtronic. Other authors: no relationships that could be construed as a conflict of interest.

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Kazawa, S., de Asmundis, C., Al Housari, M. et al. Evaluation of coronary artery disease in patients undergoing atrial fibrillation ablation: a non-invasive FFR computed tomography study. Heart Vessels 38, 757–763 (2023). https://doi.org/10.1007/s00380-022-02226-5

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