TY - JOUR
T1 - Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation
AU - Hereijgers, Maartje J.M.
AU - van der Velden, Rachel M.J.
AU - el Moussaoui, Nora
AU - Verhaert, Dominique V.M.
AU - Habibi, Zarina
AU - Luermans, Justin
AU - den Uijl, Dennis
AU - Chaldoupi, Sevasti Maria
AU - Vernooy, Kevin
AU - Schotten, Ulrich
AU - Baumert, Mathias
AU - Gietema, Hester A.
AU - Mihl, Casper
AU - Koltowski, Lukasz
AU - Franssen, Frits M.E.
AU - Simons, Sami O.
AU - Linz, Dominik
N1 - Funding Information:
This work was supported by the Netherlands Heart Foundation (Grant number 01-002-2022-0118 , EmbRACE: Electro-Molecular Basis and the theRapeutic management of Atrial Cardiomyopathy, fibrillation and associated outcomEs) and the European Union (ITN Network Personalize AF: Personalized Therapies for Atrial Fibrillation: a translational network, grant number 860974; MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation, grant number 965286).
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - Atrial fibrillation
KW - Cardiac computed tomographic angiography
KW - Expiratory airflow limitation
KW - Repurposing pre-ablation work-up
U2 - 10.1016/j.ijcha.2023.101305
DO - 10.1016/j.ijcha.2023.101305
M3 - Article
SN - 2352-9067
VL - 49
JO - IJC Heart and Vasculature
JF - IJC Heart and Vasculature
IS - 1
M1 - 101305
ER -