Association of Atrial Fibrillation Recurrence with Right Coronary Atherosclerosis and Increased Left Arterial Epicardial Fat Following Catheter Ablation-Results of a Multimodality Study.

Background: Identification of predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) can lead to better long-term results. Our aim was to investigate the association between novel CT imaging markers reflecting the severity of coronary atherosclerosis and the risk of recurrence following PVI.

Methods: This study included 80 patients with paroxysmal/persistent AF who underwent PVI. The patients were divided into two groups: Group 1-23 patients with recurrence and Group 2-57 patients without recurrence.

Results: Patients with recurrence presented with a more enlarged left atrial diameter and reduced left ventricle EF, as assessed by echocardiography. Elevated calcium scores and right coronary artery (RCA) stenosis were correlated with a higher risk of AF recurrence (25.38 ± 4.1% vs. 9.76 ± 2.32%, = 0.001). Patients with AF recurrence presented a higher left atrial volume index (LAVI) (61.38 ± 11.12 mm/m vs. 46.34 ± 12.27 mm/m, < 0.0001). The bi-atrial volume index (BAVI) was similarly higher in the AF recurrence group (98.23 ± 14.44 mm/m vs. 76.48 ± 17.61 mm/m, < 0.0001). Increased EAT volumes located around the LA (EAT-LA) were correlated with recurrence (25.55 ± 6.37 vs. 15.54 ± 8.44, < 0.0001).

Conclusions: RCA stenosis, together with atrial volumes and EAT-AS evaluated by CCTA, is associated with the risk of AF recurrence following PVI.