Impact of coronary artery disease and revascularization on recurrence of atrial fibrillation after catheter ablation: Importance of ischemia in managing atrial fibrillation

Abstract

Introduction: There are few studies analyzing the association between the presence of coronary artery disease (CAD) and recurrence of atrial fibrillation (AF). This study evaluated the clinical impact of concomitant CAD and coronary revascularization on the recurrence of AF after catheter ablation.

Methods and results: From April 2008 to December 2015, 700 consecutive patients were treated with pulmonary vein isolation for AF as the initial procedure. Of those, 681 patients who simultaneously underwent coronary angiography were investigated. Patients with at least one coronary stenosis (≥70%) were classified as having obstructive CAD. Of 681 patients, 90 patients had CAD and 42 patients underwent percutaneous coronary intervention (PCI) for lesions with perfusion abnormalities on single-photon emission tomography. The recurrence of AF was significantly more frequent in patients with CAD (56%) than in those without CAD (39%) (P = .0011). On multivariable analysis, the predictors of AF recurrence were persistent or long-standing persistent AF [hazard ratio (HR): 1.36; 95% confidence interval (CI): 1.04-1.77; P = .023], left atrial diameter (HR: 1.04; 95% CI: 1.02-1.06; P < .0001), and concomitant CAD (HR: 1.45; 95% CI: 1.05-1.97; P = .024). The recurrence of AF in patients with PCI (38%) was significantly lower than in those without PCI (72%) (P = .0006), and E/E' significantly improved in patients with PCI (71%) than in those without PCI (42%; P = .001). Performing PCI for concomitant CAD significantly reduced AF recurrence (HR: 0.39; 95% CI: 0.20-0.72; P = .002).

Conclusion: Patients with CAD had a significantly higher rate of AF recurrence than those without CAD. Coronary revascularization may reduce the recurrence of AF with improvement of left ventricular diastolic function.

Keywords: atrial fibrillation; coronary artery disease; left ventricular diastolic function; percutaneous coronary intervention; pulmonary vein isolation; recurrence.