Abstract
Background
The relationship between coronary blood flow during atrial fibrillation (AF) and improvement of cardiac function after catheter ablation (CA) for persistent AF (PeAF) is not prominent; this study was conducted to evaluate this relationship.
Methods
This was a retrospective case–control study. Eighty-five patients with PeAF (resting heart rate < 100 bpm) and heart failure with reduced ejection fraction (left ventricular ejection fraction (LVEF) < 40%) who had undergone coronary angiography within 1 week before CA were included. All patients could maintain a sinus rhythm for > 6 months after CA. The primary outcome was improvement of cardiac function with an LVEF cutoff value of > 50% during sinus rhythm 6 months after CA.
Results
In the LVEF improvement group (N = 57), patients were younger, with a higher baseline diastolic blood pressure and lower baseline brain natriuretic peptide level than the no LVEF improvement group (N = 28). Heart rate at baseline and 6 months after CA and AF duration did not differ between the two groups. Thrombolysis in myocardial infarction frame count parameters was significantly higher in the LVEF improvement (P < 0.001) than in the no LVEF improvement group. Multivariate logistic regression analysis revealed mean thrombolysis in myocardial infarction frame count as an independent factor for LVEF improvement (odds ratio, 1.72 (95% confidence interval 1.17–2.54); P = 0.006).
Conclusion
Coronary blood flow in patients with PeAF is strongly associated with improved left ventricular systolic function after the restoration of sinus rhythm by CA for PeAF and heart failure with reduced ejection fraction.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
Chugh SS, Blackshear JL, Shen WK, Hammill SC, Gersh BJ. Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol. 2001;37:371–8. https://doi.org/10.1016/s0735-1097(00)01107-4.
Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, Gillum RF, Kim YH, McAnulty JH Jr, Zheng ZJ, Forouzanfar MH, Naghavi M, Mensah GA, Ezzati M, Murray CJ. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837–47. https://doi.org/10.1161/CIRCULATIONAHA.113.005119.
Lévy S, Steinbeck G, Santini L, Nabauer M, Maceda DP, Kantharia BK, Saksena S, Cappato R. Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol. 2022;65(1):287–326. https://doi.org/10.1007/s10840-022-01195-z.
Verhaert DVM, Brunner-La Rocca HP, van Veldhuisen DJ, Vernooy K. The bidirectional interaction between atrial fibrillation and heart failure: consequences for the management of both diseases. Europace. 2021;23(Suppl 2):ii40-5. https://doi.org/10.1093/europace/euaa368.
Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D, CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417–27. https://doi.org/10.1056/NEJMoa1707855.
Prabhu S, Taylor AJ, Costello BT, Kaye DM, McLellan AJA, Voskoboinik A, Sugumar H, Lockwood SM, Stokes MB, Pathik B, Nalliah CJ, Wong GR, Azzopardi SM, Gutman SJ, Lee G, Layland J, Mariani JA, Ling LH, Kalman JM, Kistler PM. Catheter ablation versus medical rate control in atrial fibrillation and systolic dysfunction: the CAMERA-MRI study. J Am Coll Cardiol. 2017;70:1949–61. https://doi.org/10.1016/j.jacc.2017.08.041.
Packer DL, Piccini JP, Monahan KH, Al-Khalidi HR, Silverstein AP, Noseworthy PA, Poole JE, Bahnson TD, Lee KL, Mark DB, CABANA Investigators. Ablation versus drug therapy for atrial fibrillation in heart failure: results from the CABANA trial. Circulation. 2021;143:1377–90. https://doi.org/10.1161/CIRCULATIONAHA.120.050991.
Hunter RJ, Berriman TJ, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Page SP, Ullah W, Unsworth B, Mayet J, Dhinoja M, Earley MJ, Sporton S, Schilling RJ. A randomized controlled trial of catheter ablation versus medical treatment of atrial fibrillation in heart failure (the CAMTAF trial). Circ Arrhythm Electrophysiol. 2014;7:31–8. https://doi.org/10.1161/CIRCEP.113.000806.
Luo C, Wu X, Huang Z, Du Z, Hao Y, Hu C, Huang Y, Gao X. Documentation of impaired coronary blood flow by TIMI frame count method in patients with atrial fibrillation. Int J Cardiol. 2013;167:1176–80. https://doi.org/10.1016/j.ijcard.2012.03.118.
KemaloğluÖz T, Eren M, Atasoy I, Gürol T, Soylu Ö, Dağdeviren B. Are biventricular systolic functions impaired in patient with coronoray slow flow? A prospective study with three dimensional speckle tracking. Int J Cardiovasc Imaging. 2017;33:675–81. https://doi.org/10.1007/s10554-016-1054-2.
Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–88. https://doi.org/10.1161/01.CIR.93.5.879.
Range FT, Paul M, Schäfers KP, Acil T, Kies P, Hermann S, Schober O, Breithardt G, Wichter T, Schäfers MA. Myocardial perfusion in nonischemic dilated cardiomyopathy with and without atrial fibrillation. J Nucl Med. 2009;50:390–6. https://doi.org/10.2967/jnumed.108.055665.
Qin D, Mansour MC, Ruskin JN, Heist EK. Atrial fibrillation-mediated cardiomyopathy. Circ Arrhythm Electrophysiol. 2019;12:e007809. https://doi.org/10.1161/CIRCEP.119.007809.
Martin CA, Lambiase PD. Pathophysiology, diagnosis and treatment of tachycardiomyopathy. Heart. 2017;103:1543–52. https://doi.org/10.1136/heartjnl-2016-310391.
Range FT, Schäfers M, Acil T, Schäfers KP, Kies P, Paul M, Hermann S, Brisse B, Breithardt G, Schober O, Wichter T. Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation. Eur Heart J. 2007;28:2223–30. https://doi.org/10.1093/eurheartj/ehm246.
Askew JW, Miller TD, Hodge DO, Gibbons RJ. The value of myocardial perfusion single-photon emission computed tomography in screening asymptomatic patients with atrial fibrillation for coronary artery disease. J Am Coll Cardiol. 2007;50:1080–5. https://doi.org/10.1016/j.jacc.2007.05.035.
Smit MD, Tio RA, Slart RH, Zijlstra F, Van Gelder IC. Myocardial perfusion imaging does not adequately assess the risk of coronary artery disease in patients with atrial fibrillation. Europace. 2010;12:643–8.
Gimelli A, Liga R, Startari U, Giorgetti A, Pieraccini L, Marzullo P. Evaluation of ischaemia in patients with atrial fibrillation: impact of stress protocol on myocardial perfusion imaging accuracy. Eur Heart J Cardiovasc Imaging. 2015;16:781–7. https://doi.org/10.1093/ehjci/jeu322.
Jeong YH, Choi KJ, Song JM, Hwang ES, Park KM, Nam GB, Kim JJ, Kim YH. Diagnostic approach and treatment strategy in tachycardia-induced cardiomyopathy. Clin Cardiol. 2008;31:172–8. https://doi.org/10.1002/clc.20161.
Sohns C, Zintl K, Zhao Y, Dagher L, Andresen D, Siebels J, Wegscheider K, Sehner S, Boersma L, Merkely B, Pokushalov E, Sanders P, Schunkert H, Bänsch D, Mahnkopf C, Brachmann J, Marrouche NF. Impact of left ventricular function and heart failure symptoms on outcomes post ablation of atrial fibrillation in heart failure: CASTLE-AF trial. Circ Arrhythm Electrophysiol. 2020;13:e008461. https://doi.org/10.1161/CIRCEP.120.008461.
Acknowledgements
The authors would like to thank all members of the Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan. The authors did not receive support from any organization for the submitted work.
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M.T. designed the study, the main conceptual ideas, and the proof outline. M.T., T.A., and T.K. collected the data. M.T., R.H., and S.F. aided in interpreting the results and worked on the manuscript. M.H. supervised the project. M.T. wrote the manuscript with support from S.F. and M.H.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethical Review Board of Tokyo Metropolitan Hiroo Hospital (No. 15).
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Takahashi, M., Arai, T., Kimura, T. et al. Relationship between coronary blood flow and improvement of cardiac function after catheter ablation for persistent atrial fibrillation. J Interv Card Electrophysiol 66, 2063–2070 (2023). https://doi.org/10.1007/s10840-023-01542-8
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DOI: https://doi.org/10.1007/s10840-023-01542-8