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

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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.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Japan

    Satoshi Kawada, Atsuyuki Watanabe, Yoshimasa Morimoto, Koji Nakagawa, Kazufumi Nakamura & Hiroshi Ito

  2. Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan

    Nobuhiro Nishii & Hiroshi Morita

Authors
  1. Satoshi Kawada
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  2. Atsuyuki Watanabe
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  3. Yoshimasa Morimoto
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  4. Koji Nakagawa
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  5. Nobuhiro Nishii
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  6. Kazufumi Nakamura
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  7. Hiroshi Morita
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  8. Hiroshi Ito
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Correspondence to Satoshi Kawada.

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Conflict of interest

Dr. Ito reports grants and personal fees from Daiichi-Sankyo, grants from Sanofi, grants and personal fees from Berringer-Ingelheim, grants and personal fees from Bayer, grants from Pfizer, during the conduct of the study. Dr. Hiroshi Morita and Nobuhiro Nishii are affiliated with the endowed department by Japan Medtronic Inc.

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Kawada, S., Watanabe, A., Morimoto, Y. et al. Radiofrequency catheter ablation prior to percutaneous coronary intervention in patients with atrial fibrillation coexisting with stable coronary artery disease: a single-center pilot study. Heart Vessels 34, 632–640 (2019). https://doi.org/10.1007/s00380-018-1280-8

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  • DOI: https://doi.org/10.1007/s00380-018-1280-8

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