Atrial Fibrillation Recurrence Rate in Different Clinical Groups: Coronary Artery Disease and Age Matter

Abstract

BACKGROUND: Catheter ablation (CA) is an established method for atrial fibrillation (AF) treatment. Up to 20% of patients with AF develop coronary artery disease (CAD) as a secondary diagnosis. The data on whether the CAD affects the efficacy of AF ablation is contrary, while arterial hypertension is a known risk factor for AF as well as for AF recurrence after the CA.

AIM: We conducted this research to assess the AF recurrence rate and its risk factors after the primary catheter AF ablation procedure in the different clinical groups including IdiopathicAF, AF concomitant to arterial hypertension (HTN) and AF concomitant to CAD.

MATERIALS AND METHODS: Patients who underwent 451 PVI procedures performed since January 2016 to December 2017 were screened for AH, CAD and other structural heart disease. Among them 153 pts were selected for the subsequent analysis and divided into 3 groups — IdiopathicAF, AF + AH, AF + CAD.

RESULTS: The presence of CAD (r = 0.313, p < 0.001), age (r = 0.224, p = 0.008), CHA2DS2-VASc score (r = 0.279, p = 0.001), history of MI (r = 0.240, p = 0.004), LA size (r = 0.204, p = 0.018) were correlated with the recurrence rate. In the AF + CAD group patients older than 65 years demonstrated dramatically lower AF-free survival rate (37.5%) in comparison to younger CAD population (75%, log-rank p < 0.001) as well as to younger and older non-CAD patients.

CONCLUSIONS: The presence of CAD should always attract the attention of physicians before considering the AF ablation as an option to treatment. Elderly CAD patients have the lowest ablation efficacy and the best strategy for this group (more extensive primary ablation or conversion to the permanent AF) needs to be studied.

Keywords

atrial fibrillation / catheter ablation / pulmonary vein isolation / arterial hypertension / coronary artery disease

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