Background: Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist.Hypothesis: To investigate the prognosis of catheter ablation versus drug therapy in patients with AF and SCAD.Methods: In total, 25 512 patients with AF in the Chinese AF Registry between 2011 and 2019 were screened for SCAD. 815 patients with AF and SCAD underwent catheter ablation therapy were matched with patients by drug therapy in a 1:1 ratio. Primary end point was composite of thromboembolism, coronary events, major bleeding, and all-cause death.The secondary endpoints were each component of the primary endpoint and AF recurrence.Results: Over a median follow-up of 45 ± 23 months, the patients in the catheter ablation group had a higher AF recurrence-free rate (53.50% vs. 18.41%, p < .01). In multivariate analysis, there was no significant difference between the strategy of catheter ablation and drug therapy in primary composite end point (adjusted HR 074, 95%CI 0.54-1.002, p = .0519). However, catheter ablation was associated with fewer all-cause death independently (adjusted HR 0.36, 95%CI 0.22-0.59, p < .01). In subgroup analysis, catheter ablation was an independent risk factor for all-cause death in the high-stroke risk group (adjusted HR 0.39, 95%CI 0.23-0.64, p < .01), not in the low-medium risk group (adjusted HR 0.17, 95%CI 0.01-2.04, p = .17).

Background  Left ventricular thrombus (LVT) is a common complication of dilated cardiomyopathy (DCM), causing morbidity and mortality. Methods  This study retrospectively analyzed patients with DCM from January 2002 to August 2020 in Beijing Anzhen Hospital. Clinical characteristics were compared between the LVT group and the age and sex 1:4 matched with the LVT absent group. The receiver operator characteristic (ROC) curve was plotted to evaluate the diagnostic value of D-dimer predicting LVT occurrence in DCM. Results  A total of 3,134 patients were screened, and LVT was detected in 72 (2.3%) patients on echocardiography. The patients with LVT had higher D-dimer, fibrinogen, and lower systolic blood pressure than those without LVT. The ejection fraction (EF) was lower and left ventricular end-systolic diameter was larger in the LVT group. Severe mitral regurgitation (MR) was more common in the LVT absent groups. The prevalence of atrial fibrillation was lower in the LVT group. The ROC curve analysis yielded an optimal cut-off value of 444 ng/mL DDU (D-dimer units) for D-dimer to predict the presence of LVT. Multivariable binary logistic regression analysis revealed that EF (OR = 0.90, 95% CI = 0.86–0.95), severe MR (OR = 0.19, 95% CI = 0.08–0.48), and D-dimer level (OR = 15.4, 95% CI = 7.58–31.4) were independently associated with LVT formation. Conclusion  This study suggested that elevated D-dimer levels (>444 ng/mL DDU) and reduced EF were independently associated with increased risk of LVT formation. Severe MR could decrease the incidence of LVT.

Background: CLBBB and AF are not uncommon coexisted. The impact of CLBBB on long-term prognosis of catheter ablation of AF has not been well determined. Objectives: This study aims to explore the long-term outcomes of patients with atrial fibrillation (AF) and complete left bundle branch block (CLBBB) after catheter ablation. Methods: Forty-two patients with CLBBB of the 11,752 patients who underwent catheter ablation of AF from 2011 to 2020 were enrolled as CLBBB group. After propensity score matching in a 1:4 ratio, 168 AF patients without CLBBB were enrolled as Non-CLBBB group. The primary endpoint was a composite of stroke, all-cause mortality, and cardiovascular hospitalization. The secondary endpoint was AF recurrence after single ablation. Results: The incidence of the primary endpoint in the CLBBB group was significantly higher than in the Non-CLBBB group (21.4% vs. 6.5%, HR 3.98, 95%CI 1.64-9.64, P = 0.002). The recurrence rates in the CLBBB group and the Non-CLBBB group were 54.8% and 31.5% (HR 1.71, 95%CI 1.04-2.79, P = 0.034), respectively. Multivariate analysis showed that CLBBB was an independent risk factor for both primary endpoint (HR 2.92, 95%CI 1.17-3.34, P = 0.022) and secondary endpoint (HR 2.19, 95%CI 1.09-4.40, P = 0.031) in patients with AF after catheter ablation. Conclusions: CLBBB significantly increased the risk of a composite endpoint of stroke, all-cause mortality, and cardiovascular hospitalization after catheter ablation in patients with AF. CLBBB also independently predicted recurrence in these patients.