Abstract 3823: Abnormal Noninvasive Coronary Angiogram in 64-Slice Computed Tomography: Predictor for Atrial Fibrillation Recurrence
The impact of non-invasive coronary angiogram on atrial fibrillation recurrence up to now has not been determined. However, even clinically undetected coronary artery disease non-invasively detectable by multislice computed tomography (MSCT) may play a role in maintaining an arrhythmogenic substrate. We therefore included 63 consecutive patients (55 male, 8 female, age 68±21years) after successful (=24h restored sinus rhythm) electrical cardiover-sion into our study and performed non-invasive coronary angiography and calcium scoring with MSCT (Philips Brilliance, 64x0.625mm collimation, 0.4sec gantry rotation time). Exclusion criteria were: Valvular heart disease, known or symptomatic coronary artery disease, untreated hyperthyroidism, heart failure NYHA IV or kidney failure. During 4±3 months follow-up in 24 of 63 (=38%) patients a symptomatic recurrence of atrial fibrillation could be documented. Patients with and without atrial fibrillation recurrence did not differ with respect to age, antiarrhythmic drug therapy and duration of atrial fibrillation before electrical cardioversion. However, patients with atrial fibrillation recurrence had significantly higher left atrial size (48±20mm vs. 41±16mm, p=0.032), lower ejection fraction (52±14% vs. 62±21%, p=0.047) and higher coronary calcium volume scores (854±132 vs. 515±212, p=0.003). Multivariate analysis revealed ejection fraction < 40% (p=0.029) and coronary calcium volume score > 400 (p=0.0023, log-rank test) as independent predictors for atrial fibrillation recurrence. In 16 of 24 patients with atrial fibrillation recurrence noninvasive coronary angiogram revealed significant stenosis (> 70%) in 14 of 16 patients, confirmed by invasive angiogram in all 14 patients. All those 14 patients had a coronary calcium volume score > 600.
Conclusion: Thus, non-invasive coronary angiography identifies patients at substantial risk for recurrence of atrial fibrillation and underlying silent severe coronary artery disease that possibly maintains the arrhythmogenic substrate and therefore should be considered in patients with atrial fibrillation recurrences.