Coronary Endothelial Dysfunction Is Associated With Increased Risk of Incident Atrial Fibrillation

Background Coronary artery disease risk factors are associated with atrial fibrillation (AF) and coronary endothelial dysfunction (CED). We hypothesized that CED is associated with increased risk of incident AF among patients with chest pain and nonobstructive coronary artery disease. Methods and Results Three hundred patients with chest pain, nonobstructive coronary artery disease, and no history of AF underwent intracoronary acetylcholine infusion for evaluation of baseline epicardial (decrease in mid-left anterior descending coronary artery diameter in response to acetylcholine) and microvascular (34 mL/m ) left atrial volume index (odds ratio, 3.87; 95% CI, 1.60-9.11) were independent predictors of incident AF. Conclusions Patients with normal coronary endothelial function, as compared with those with CED and similar AF risk factors, have significantly lower incidence of AF on long-term follow-up. The potential mechanistic link between vascular dysfunction and AF development warrants further investigation.