Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls

Background Idiopathic atrial fibrillation (AF) refers to a clinically lacking cardiovascular or pulmonary disease generating the pathophysiologic substrate for the arrhythmia. However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected unde...

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Veröffentlicht in:Heart rhythm 2012-12, Vol.9 (12), p.1923-1929
Hauptverfasser: Weijs, Bob, MD, PhD, Pisters, Ron, MD, PhD, Haest, Rutger J., MD, Kragten, Johannes A., MD, PhD, Joosen, Ivo A., MD, Versteylen, Mathijs, MD, Timmermans, Carl C., MD, PhD, Pison, Laurent, MD, Blaauw, Yuri, MD, PhD, Hofstra, Leonard, MD, PhD, Nieuwlaat, Robby, PhD, Wildberger, Joachim, MD, PhD, Crijns, Harry J., MD, PhD, FHRS
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container_end_page 1929
container_issue 12
container_start_page 1923
container_title Heart rhythm
container_volume 9
creator Weijs, Bob, MD, PhD
Pisters, Ron, MD, PhD
Haest, Rutger J., MD
Kragten, Johannes A., MD, PhD
Joosen, Ivo A., MD
Versteylen, Mathijs, MD
Timmermans, Carl C., MD, PhD
Pison, Laurent, MD
Blaauw, Yuri, MD, PhD
Hofstra, Leonard, MD, PhD
Nieuwlaat, Robby, PhD
Wildberger, Joachim, MD, PhD
Crijns, Harry J., MD, PhD, FHRS
description Background Idiopathic atrial fibrillation (AF) refers to a clinically lacking cardiovascular or pulmonary disease generating the pathophysiologic substrate for the arrhythmia. However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease. Objective The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF. Methods Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score–matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography. Results Controls more often showed a family history of CAD (38% vs 15%, P
doi_str_mv 10.1016/j.hrthm.2012.08.013
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However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease. Objective The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF. Methods Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score–matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography. Results Controls more often showed a family history of CAD (38% vs 15%, P &lt;.001), had a higher prevalence of smoking (25% vs 14%, P = .021), higher fasting blood glucose levels (5.5 ± 0.7 mmol/L vs 5.4 ± 0.6 mmol/L, P = .025), and smaller atrial diameters (37 ± 4 mm vs 40 ± 5 mm, P &lt;.001) compared to AF patients. Notwithstanding the above, idiopathic AF patients significantly more often suffered from subclinical CAD compared to controls (49% vs 34%, P = .008). Multivariable regression analysis revealed that beside (as expected) age and gender, a history of AF and left atrial diameter were significant predictors of underlying CAD. Conclusion Half of patients originally diagnosed with idiopathic paroxysmal AF show concealed underlying CAD. The detection and treatment of CAD at an early stage could improve the prognosis of these patients.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2012.08.013</identifier><identifier>PMID: 22885921</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Cardiac computed tomographic angiography ; Cardiovascular ; Coronary Angiography ; Coronary artery disease ; Coronary Artery Disease - complications ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - epidemiology ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Rate - physiology ; Humans ; Idiopathic atrial fibrillation ; Male ; Middle Aged ; Netherlands - epidemiology ; Prevalence ; Retrospective Studies ; Sinoatrial Node - physiology ; Tomography, X-Ray Computed</subject><ispartof>Heart rhythm, 2012-12, Vol.9 (12), p.1923-1929</ispartof><rights>Heart Rhythm Society</rights><rights>2012 Heart Rhythm Society</rights><rights>Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-65b97037695e3ede813b8d851ababffab3b66227d51c0b76c9795b293422a5bd3</citedby><cites>FETCH-LOGICAL-c414t-65b97037695e3ede813b8d851ababffab3b66227d51c0b76c9795b293422a5bd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527112008715$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22885921$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Weijs, Bob, MD, PhD</creatorcontrib><creatorcontrib>Pisters, Ron, MD, PhD</creatorcontrib><creatorcontrib>Haest, Rutger J., MD</creatorcontrib><creatorcontrib>Kragten, Johannes A., MD, PhD</creatorcontrib><creatorcontrib>Joosen, Ivo A., MD</creatorcontrib><creatorcontrib>Versteylen, Mathijs, MD</creatorcontrib><creatorcontrib>Timmermans, Carl C., MD, PhD</creatorcontrib><creatorcontrib>Pison, Laurent, MD</creatorcontrib><creatorcontrib>Blaauw, Yuri, MD, PhD</creatorcontrib><creatorcontrib>Hofstra, Leonard, MD, PhD</creatorcontrib><creatorcontrib>Nieuwlaat, Robby, PhD</creatorcontrib><creatorcontrib>Wildberger, Joachim, MD, PhD</creatorcontrib><creatorcontrib>Crijns, Harry J., MD, PhD, FHRS</creatorcontrib><title>Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Background Idiopathic atrial fibrillation (AF) refers to a clinically lacking cardiovascular or pulmonary disease generating the pathophysiologic substrate for the arrhythmia. However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease. Objective The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF. Methods Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score–matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography. Results Controls more often showed a family history of CAD (38% vs 15%, P &lt;.001), had a higher prevalence of smoking (25% vs 14%, P = .021), higher fasting blood glucose levels (5.5 ± 0.7 mmol/L vs 5.4 ± 0.6 mmol/L, P = .025), and smaller atrial diameters (37 ± 4 mm vs 40 ± 5 mm, P &lt;.001) compared to AF patients. Notwithstanding the above, idiopathic AF patients significantly more often suffered from subclinical CAD compared to controls (49% vs 34%, P = .008). Multivariable regression analysis revealed that beside (as expected) age and gender, a history of AF and left atrial diameter were significant predictors of underlying CAD. Conclusion Half of patients originally diagnosed with idiopathic paroxysmal AF show concealed underlying CAD. 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However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease. Objective The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF. Methods Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score–matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography. Results Controls more often showed a family history of CAD (38% vs 15%, P &lt;.001), had a higher prevalence of smoking (25% vs 14%, P = .021), higher fasting blood glucose levels (5.5 ± 0.7 mmol/L vs 5.4 ± 0.6 mmol/L, P = .025), and smaller atrial diameters (37 ± 4 mm vs 40 ± 5 mm, P &lt;.001) compared to AF patients. Notwithstanding the above, idiopathic AF patients significantly more often suffered from subclinical CAD compared to controls (49% vs 34%, P = .008). Multivariable regression analysis revealed that beside (as expected) age and gender, a history of AF and left atrial diameter were significant predictors of underlying CAD. Conclusion Half of patients originally diagnosed with idiopathic paroxysmal AF show concealed underlying CAD. The detection and treatment of CAD at an early stage could improve the prognosis of these patients.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22885921</pmid><doi>10.1016/j.hrthm.2012.08.013</doi><tpages>7</tpages></addata></record>
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subjects Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Cardiac computed tomographic angiography
Cardiovascular
Coronary Angiography
Coronary artery disease
Coronary Artery Disease - complications
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - epidemiology
Electrocardiography
Female
Follow-Up Studies
Heart Rate - physiology
Humans
Idiopathic atrial fibrillation
Male
Middle Aged
Netherlands - epidemiology
Prevalence
Retrospective Studies
Sinoatrial Node - physiology
Tomography, X-Ray Computed
title Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls
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