Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation

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  • Maartje J.M. Hereijgers
  • Rachel M.J. van der Velden
  • Nora el Moussaoui
  • Dominique V.M. Verhaert
  • Zarina Habibi
  • Justin Luermans
  • Dennis den Uijl
  • Sevasti Maria Chaldoupi
  • Kevin Vernooy
  • Ulrich Schotten
  • Mathias Baumert
  • Hester A. Gietema
  • Casper Mihl
  • Lukasz Koltowski
  • Frits M.E. Franssen
  • Sami O. Simons
  • Dr Linz, Dominik Karl

Background: In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments from the pre-ablation work-up to identify and understand the characteristics of affected patients. Methods: We screened 110 consecutive AF patients scheduled for catheter ablation with handheld spirometry. Routine pre-ablation work-up included cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. CCTA was analyzed qualitatively for emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of expiratory airflow limitation. Results: We found that 25 % of patients had expiratory airflow limitation, which was undiagnosed in 86 % of these patients. These patients were more likely to have pulmonary abnormalities on CCTA, including emphysema (odds ratio [OR] 4.2, 95 % confidence interval [CI] 1.12–15.1, p < 0.05) and bronchial wall thickening (OR 2.6, 95 % CI 1.0–6.5, p < 0.05). The absence of pulmonary abnormalities on CCTA accurately distinguished patients with normal lung function from those with airflow limitation (negative predictive value: 85 %). Echocardiography and polygraphy did not contribute significantly to identifying airflow limitation. Conclusions: In conclusion, routine pre-ablation CCTA can detect pulmonary abnormalities in AF patients with airflow limitation, guiding further pulmonary assessment. Future studies should investigate its impact on ablation procedure success.

Original languageEnglish
Article number101305
JournalIJC Heart and Vasculature
Volume49
Number of pages9
ISSN2352-9067
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)

    Research areas

  • Atrial fibrillation, Cardiac computed tomographic angiography, Expiratory airflow limitation, Repurposing pre-ablation work-up

ID: 374831092