Radiofrequency catheter ablation prior to percutaneous coronary intervention in patients with atrial fibrillation coexisting with stable coronary artery disease: a single-center pilot study.

Abstract

Atrial fibrillation (AF) frequently coexists with cardiovascular disease (CAD) in a clinical setting. However, the optimum therapy for AF patients who have concomitant CAD is unclear. We retrospectively examined the efficacy and safety of radiofrequency catheter ablation (RFCA) prior to percutaneous coronary intervention (PCI) in patients with AF who had concomitant stable CAD. Between January 2014 and December 2015, a total 264 patients (179 men; mean age, 65.5 ± 10.1 years) who were referred to undergo a first RFCA procedure were reviewed in this study. Of the 264 patients, 41 (15.5%) had stable CAD detected by multi-detector computed tomography before RFCA. Thirty-seven patients who had AF with stable CAD were divided into two treatment arms: (1) RFCA prior to PCI (n = 13) and (2) PCI prior to RFCA (n = 24) [four patients excluded because of left main coronary artery disease (LMCA) or triple vessel disease (TVD)]. The median follow-up was 14 (IQR 8-19) months. There was no significant difference in AF recurrence rate after the procedure between the RFCA first group and PCI first group (P = 0.515). No symptomatic cardiovascular events occurred the during follow-up period. The PCI first group had a significantly longer duration of triple therapy (188.5 ± 167 days vs 5.6 ± 24.5 days, P = 0.01) and all of the four bleeding events occurred during triple therapy (P = 0.01). The results of this single-center pilot study suggested that prior RFCA in patients with AF coexisting with CAD could have fewer serious bleeding events than prior PCI.

• Authors: Satoshi Kawada, Atsuyuki Watanabe, Yoshimasa Morimoto, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito
• Journal: Heart and vessels (Heart Vessels) Vol. 34 Issue 4 Pg. 632-640 (Apr 2019) ISSN: 1615-2573 [Electronic] Japan
• PMID: 30324245 (Publication Type: Journal Article)

Topics

• Aged
• Atrial Fibrillation (complications, physiopathology, surgery)
• Catheter Ablation (methods)
• Coronary Angiography
• Coronary Artery Disease (complications, diagnosis, surgery)
• Coronary Vessels (diagnostic imaging, surgery)
• Female
• Follow-Up Studies
• Heart Conduction System (physiopathology, surgery)
• Humans
• Male
• Middle Aged
• Multidetector Computed Tomography
• Percutaneous Coronary Intervention (methods)
• Pilot Projects
• Pulmonary Veins (surgery)
• Recurrence
• Retrospective Studies
• Treatment Outcome