Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation

Range, Felix T; Schäfers, Michael; Açıl, Tayfun; Schäfers, Klaus P.; Kies, Peter; Paul, Matthias; Hermann, Sven; Brisse, B; Breithardt, Günter; Schober, Otmar; Wichter, Thomas

doi:10.1093/eurheartj/ehm246

Cited by 101 publications

(96 citation statements)

References 15 publications

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“…Our study supports previous findings of impaired stress MBF in male patients with persistent AF determined using positron emission tomography6 and extends the investigation to female patients and those with paroxysmal AF who were in SR at the time of imaging. Stress MBF was lower in all AF patients, irrespective of the rhythm during the preablation CMR.…”

Section: Discussionsupporting

confidence: 90%

“…Stress MBF was lower in all AF patients, irrespective of the rhythm during the preablation CMR. This difference also persisted after ablation, even in the subgroup of patients with no evidence of recurrent AF on prolonged ambulatory monitoring, suggesting that the previously reported improvement in this parameter in a very small number of patients following cardioversion6 may have been due to the play of chance. These novel findings imply that the reduction in stress MBF in patients with paroxysmal or persistent AF is not a direct effect of the arrhythmia itself but may reflect an underlying coronary endothelial dysfunction 11…”

Section: Discussionmentioning

confidence: 66%

“…Baseline MBF is closely related to baseline RPP15; thus, baseline MBF was corrected for baseline RPP using the formula baseline MBF corrected =baseline MBF/(baseline RPP/10 000), to account for differences in cardiac work, as previously described 6. In accordance with previous studies, adenosine‐stress–induced MBF was not corrected because this parameter is grossly independent of RPP 16.…”

Section: Methodsmentioning

confidence: 92%

“…Power calculations were based on prior data reporting a baseline MBF of 0.95±0.19 mL/(min·mL) in AF patients and 1.14±0.22 mL/(min·mL) in matched controls, and a MBF during adenosine stress of 2.07±0.80 mL/(min·mL) in AF patients and 3.33±0.78 mL/(min·mL) in matched controls 6. We calculated that inclusion of at least 48 patients and 24 controls (2:1 allocation ratio) would give >90% power to detect a difference of ≥15% in baseline MBF and ≥20% in stress MBF, respectively, between patients and controls (2‐sided α=0.05).…”

Section: Methodsmentioning

confidence: 99%

“…Clinicians are also familiar with patients with AF presenting with chest pain and evidence of cardiac ischemia or necrosis, such as “rate‐related” ST depression or troponin release, in the absence of significant epicardial coronary artery disease 4, 5. Despite these intriguing observations, few studies have systematically investigated myocardial perfusion in patients with AF 6, 7…”

Section: Introductionmentioning

confidence: 99%

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Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation

Wijesurendra

Liu

Notaristefano

et al. 2018

JAHA

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BackgroundAtrial fibrillation (AF) is associated with myocardial infarction, and patients with AF and no obstructive coronary artery disease can present with symptoms and evidence of cardiac ischemia. We hypothesized that microvascular coronary dysfunction underlies these observations.Methods and ResultsMyocardial blood flow (MBF) at baseline and during adenosine stress and left ventricular and left atrial function were evaluated by magnetic resonance in 49 patients with AF (25 paroxysmal, 24 persistent) with no history of epicardial coronary artery disease or diabetes mellitus, before and 6 to 9 months after ablation. Findings were compared with those obtained in matched controls in sinus rhythm (n=25). Before ablation, patients with AF had impaired left atrial function and left ventricular ejection fraction and strain indices (all P<0.05 versus controls). MBF was impaired in patients both under baseline conditions (1.21±0.24 mL/min per g·[mm Hg·bpm/104]−1 versus 1.34±0.28 mL/min per g·[mm Hg·bpm/104]−1 in controls, P=0.044) and during adenosine stress (2.29±0.48 mL/min per g versus 2.73±0.37 mL/min per g in controls, P<0.001). Under baseline conditions, MBF correlated with left ventricular strain and left atrial function (all P≤0.001), so that cardiac function was most impaired in patients with the lowest MBF. Baseline and stress MBF remained unchanged postablation (both P=ns), and baseline MBF showed similar correlations with functional indices to those present preablation (all P≤0.001).ConclusionsBaseline and stress MBF are significantly impaired in patients with AF but no epicardial coronary artery disease. Reduction in MBF is proportional to severity of left ventricular and left atrial dysfunction, even after successful ablation. Coronary microvascular dysfunction may be a relevant pathophysiological mechanism in patients with a history of AF.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 66%

Section: Methodsmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation

Wijesurendra

Liu

Notaristefano

et al. 2018

JAHA

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Prevalence of Arrhythmias in Patients With Coronary Microvascular Dysfunction

Chitturi,

Kumar,

Hill

et al. 2024

Cathet Cardio Intervent

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BackgroundCoronary microvascular dysfunction (CMD) is an important cause of angina with nonobstructive coronary arteries (ANOCA). It is unclear whether CMD is associated with arrhythmia.AimsThis study aimed to evaluate the prevalence of arrhythmias in patients with ANOCA and CMD compared to those in patients with ANOCA without CMD.MethodsIn this observational study of the Coronary Microvascular Disease Registry (NCT05960474), patients with ANOCA who underwent invasive coronary functional assessment for CMD were included. The diagnosis of arrhythmia was based on 12‐lead electrocardiography (ECG), or clinical diagnosis accompanied by ECG evidence within 1 year before CMD evaluation.ResultsThe study included 262 patients; 66 (25.2%) were CMD‐positive. Patients with CMD were older, and there was no difference in history of heart failure and baseline left ventricular ejection fraction compared to those without CMD. Premature atrial contractions (PACs) (25.8% vs. 5.6%; p < 0.001), supraventricular tachycardia (SVT) (24.2% vs. 6.6%; p < 0.001), premature ventricular complexes (PVCs) (43.9% vs. 10.7%; p < 0.001), nonsustained ventricular tachycardia (NSVT) (28.8% vs. 3.1%; p < 0.001), and accelerated idioventricular rhythm (9.1% vs. 2.6%; = 0.02) were more common in CMD‐positive patients. In a multivariate analysis adjusting for baseline differences and other variables clinically associated with arrhythmia, CMD was associated with PACs (odds ratio [OR]: 4.7; 95% confidence interval [CI]: 1.8–11.9), SVT (OR: 3.5; 95% CI: 1.5–8.6), PVCs (OR: 5.9; 95% CI: 2.6–13.0), and NSVT (OR: 9.5; 95% CI: 3.2–27.7).ConclusionPatients with ANOCA and CMD have a higher likelihood of arrhythmias, especially ventricular arrhythmias.

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Comparison of prognosis and outcomes of catheter ablation versus drug therapy in patients with atrial fibrillation and stable coronary artery disease: A prospective propensity‐score matched cohort study

Cui

Dong

et al. 2021

Clinical Cardiology

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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).

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Impaired myocardial perfusion and perfusion reserve associated with increased coronary resistance in persistent idiopathic atrial fibrillation

Abstract: In AF, MBF at baseline, at hyperaemia, and at CPT is reduced, whereas CVR under hyperaemic conditions is increased. Following electrical cardioversion, these findings are partly reversible and therefore most likely secondary to the arrhythmia.

Cited by 101 publications

References 15 publications

Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation

Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation

Prevalence of Arrhythmias in Patients With Coronary Microvascular Dysfunction

Comparison of prognosis and outcomes of catheter ablation versus drug therapy in patients with atrial fibrillation and stable coronary artery disease: A prospective propensity‐score matched cohort study

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