无症状性左旋支动脉狭窄与持续性心房颤动消融术后较高的心律失常复发率相关。

Asymptomatic left circumflex artery stenosis is associated with higher arrhythmia recurrence after persistent atrial fibrillation ablation.

作者信息

Garcia Rodrigue, Clouard Mathilde, Plank Fabian, Degand Bruno, Philibert Séverine, Laurent Gabriel, Poupin Pierre, Sakhy Saliman, Gras Matthieu, Stühlinger Markus, Szegedi Nándor, Herczeg Szilvia, Simon Judit, Crijns Harry J G M, Marijon Eloi, Christiaens Luc, Guenancia Charles

机构信息

Cardiology Department, University Hospital of Poitiers, Poitiers, France.

Centre d'Investigation Clinique 1402, University Hospital of Poitiers, Poitiers, France.

出版信息

Front Cardiovasc Med. 2022 Sep 26;9:873135. doi: 10.3389/fcvm.2022.873135. eCollection 2022.

DOI:10.3389/fcvm.2022.873135

PMID:36225960

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9548703/

Abstract

BACKGROUND

The pathophysiology of persistent atrial fibrillation (AF) remains unclear. While several studies have demonstrated an association between myocardial infarction and atrial fibrillation, the role of stable coronary artery disease (CAD) is still unknown. As a result, we aimed to assess the association between CAD obstruction and AF recurrence after persistent AF ablation in patients with no history of CAD.

MATERIALS AND METHODS

This observational retrospective study included consecutive patients who underwent routine preprocedural cardiac computed tomography (CCT) before persistent AF ablation between September 2015 and June 2018 in 5 European University Hospitals. Exclusion criteria were CAD or coronary revascularization previously known or during follow-up. Obstructive CAD was defined as luminal stenosis ≥ 50%.

RESULTS

All in all, 496 patients (mean age 61.8 ± 10.0 years, 76.2% males) were included. CHADS-VASc score was 0 or 1 in 225 (36.3%) patients. Obstructive CAD was present in 86 (17.4%) patients. During the follow-up (24 ± 19 months), 207 (41.7%) patients had AF recurrence. The recurrence rate was not different between patients with and without obstructive CAD (43.0% vs. 41.5%, respectively; = 0.79). When considering the location of the stenosis, the recurrence rate was higher in the case of left circumflex obstruction: 56% vs. 32% at 2 years (log-rank ≤ 0.01). After Cox multivariate analysis, circumflex artery obstruction (HR 2.32; 95% CI 1.36-3.98; < 0.01) was independently associated with AF recurrence.

CONCLUSION

Circumflex artery obstruction detected with CCT was independently associated with 2-fold increase in the risk of AF recurrence after persistent AF ablation. Further research is necessary to evaluate this pathophysiological relationship.

摘要

背景

持续性心房颤动（AF）的病理生理学仍不清楚。虽然多项研究表明心肌梗死与心房颤动之间存在关联，但稳定型冠状动脉疾病（CAD）的作用仍不明确。因此，我们旨在评估无CAD病史患者在持续性AF消融术后CAD梗阻与AF复发之间的关联。

材料与方法

这项观察性回顾性研究纳入了2015年9月至2018年6月期间在5家欧洲大学医院接受持续性AF消融术前常规心脏计算机断层扫描（CCT）的连续患者。排除标准为既往已知或随访期间有CAD或冠状动脉血运重建。阻塞性CAD定义为管腔狭窄≥50%。

结果

总共纳入了496例患者（平均年龄61.8±10.0岁，76.2%为男性）。225例（36.3%）患者的CHADS-VASc评分为0或1。86例（17.4%）患者存在阻塞性CAD。在随访期间（24±19个月），207例（41.7%）患者发生AF复发。有和无阻塞性CAD的患者复发率无差异（分别为43.0%和41.5%；P=0.79）。考虑狭窄部位时，左旋支阻塞患者的复发率较高：2年时为56% vs. 32%（对数秩P≤0.01）。经过Cox多因素分析，左旋支动脉阻塞（HR 2.32；95%CI 1.36-3.98；P<0.01）与AF复发独立相关。