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Higher coronary artery calcium score is associated with increased risk of atrial fibrillation recurrence after catheter ablation

Published:November 10, 2022DOI:https://doi.org/10.1016/j.jcct.2022.10.002

      Abstract

      Background

      Coronary artery calcium score (CACS) is associated with an increased risk of atrial fibrillation (AF) development, but scarce data are available regarding the impact on AF recurrence. This study aims to assess the impact of CACS on AF recurrence following catheter ablation.

      Methods

      Retrospective study of patients with AF undergoing cardiac computed tomography (CCT) before ablation (2017–2019). Patients with coronary artery disease (CAD), significant valvular heart disease and previous catheter ablation were excluded. A cut-off of CACS ≥ 100 was used according to literature.

      Results

      A total of 311 patients were included (median age 57 [48, 64] years, 65% men and 21% with persistent AF). More than half of the patients had a CACS > 0 (52%) and 18% a CACS ≥ 100. Patients with CACS ≥ 100 were older (64 [59, 69] vs 55 [46, 63] years, p ​< ​0.001), had more frequently hypertension (68% vs 42%, p ​< ​0.001) and diabetes mellitus (21% vs 10%, p ​= ​0.020). During a median follow-up of 34 months (12–57 months), 98 patients (32%) had AF recurrence. CACS ≥ 100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 2.0; 95% confidence interval [CI], 1.3–3.1, p ​= ​0.002). After covariate adjustment, CACS ≥ 100 and persistent AF remained independent predictors of AF recurrence (HR, 1.7; 95% CI, 1.0–2.8, p ​= ​0.039 and HR, 2.0; 95% CI, 1.3–3.2, p ​= ​0.004, respectively).

      Conclusion

      An opportunistic evaluation of CACS could be an important tool to improve clinical care considering that CACS ≥ 100 was independently associated with a 69% increase in the risk of AF recurrence after first catheter ablation.

      Keywords

      Abbreviations:

      AF (Atrial fibrillation), CACS (Coronary artery calcium score), CAD (Coronary artery disease), CCT (Cardiac computed tomography), CI (Confidence interval), CV (Cardiovascular), ESC (European Society of Cardiology), HR (Hazard ratio), IQR (Interquartile range), LA (Left atrium)
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