Dudink Elton A M P, Bidar Elham, Jacobs Judith, van Hunnik Arne, Zeemering Stef, Weijs Bob, Luermans Justin G L M, Maesen Bart A E, Cheriex Emile C, Maessen Jos G, Hoorntje Jan C A, Schotten Ulrich, Crijns Harry J G M, Verheule Sander
Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiothoracic Surgery, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
Int J Cardiol Heart Vasc. 2021 May 19;34:100794. doi: 10.1016/j.ijcha.2021.100794. eCollection 2021 Jun.
Patients with a history of myocardial infarction and coronary artery disease (CAD) have a higher risk of developing AF. Conversely, patients with atrial fibrillation (AF) have a higher risk of developing myocardial infarction, suggesting a link in underlying pathophysiology. The aim of this study was to assess whether coronary angiographic parameters are associated with a substrate for AF in patients without a history of AF.
During cardiac surgery in 62 patients (coronary artery bypass grafting (CABG;n = 47), aortic valve replacement (AVR;n = 9) or CABG + AVR (n = 6)) without a history of clinical AF (age 65.4 ± 8.5 years, 26.2% female), AF was induced by burst pacing. The preoperative coronary angiogram (CAG) was assessed for the severity of CAD, and the adequacy of atrial coronary blood supply as quantified by a novel scoring system including the location and severity of right coronary artery disease in relation to the right atrial branches. Epicardial mapping of the right atrium (256 unipolar electrodes) was used to assess the complexity of induced AF.
There was no association between the adequacy of right atrial coronary blood supply on preoperative CAG and AF complexity parameters. Multivariable analysis revealed that only increasing age (B0.232 (0.030;0.433),p = 0.03) and the presence of 3VD (B3.602 (0.187;7.018),p = 0.04) were independently associated with an increased maximal activation time difference.
The adequacy of epicardial right atrial blood supply is not associated with increased complexity of induced atrial fibrillation in patients without a history of clinical AF, while age and the extent of ventricular coronary artery disease are.
有心肌梗死和冠状动脉疾病（CAD）病史的患者发生房颤的风险较高。相反，患有心房颤动（AF）的患者发生心肌梗死的风险较高，这表明潜在的病理生理学存在关联。本研究的目的是评估冠状动脉造影参数是否与无房颤病史患者的房颤基质相关。
在62例无临床房颤病史（年龄65.4±8.5岁，女性占26.2%）的患者进行心脏手术期间（冠状动脉搭桥术（CABG；n = 47）、主动脉瓣置换术（AVR；n = 9）或CABG + AVR（n = 6）），通过短阵猝发刺激诱发房颤。评估术前冠状动脉造影（CAG）以确定CAD的严重程度，并通过一种新的评分系统量化心房冠状动脉血供的充足程度，该系统包括右冠状动脉疾病相对于右心房分支的位置和严重程度。使用右心房的心外膜标测（256个单极电极）评估诱发房颤的复杂性。
术前CAG上右心房冠状动脉血供的充足程度与房颤复杂性参数之间无关联。多变量分析显示，只有年龄增加（B0.232（0.030；0.433），p = 0.03）和存在三支血管病变（B3.602（0.187；7.018），p = 0.04）与最大激活时间差增加独立相关。
在无临床房颤病史的患者中，心外膜右心房血供的充足程度与诱发房颤的复杂性增加无关，而年龄和心室冠状动脉疾病的程度则与之相关。
