Repurposing Catheter Ablation Work-Up to Detect Expiratory Airflow Limitation in Patients with Atrial Fibrillation

Abstract

AbstractBackgroundIn atrial fibrillation (AF) patients, presence of expiratory airflow limitation adds to overall morbidity and may impair the response to heart rhythm control strategies. 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 airflow limitation and understand the characteristics of affected patients.MethodsWe screened 110 consecutive AF patients scheduled for catheter ablation using handheld spirometry devices. As part of routine pre-ablation work-up, patients also underwent cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. Qualitative analysis of CCTA focused on identifying emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of airflow limitation.ResultsWe found that 25% of patients had expiratory airflow limitation, which was undiagnosed in 86% of these patients. Patients with this condition 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.ConclusionsRoutine pre-ablation CCTA can help identify pulmonary abnormalities in AF patients with expiratory airflow limitation. This information can guide the need for further pulmonary assessment in these patients.

Note:
Funding declaration: This work was supported by the Netherlands Heart Foundation (Grant number 01-002-2022- 0118, EmbRACE: Electro-Molecular Basis and the theRapeutic management of Atria 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).

Conflict of Interests: US received grants, consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited, (United Kingdom), Bayer Healthcare (Germany). US is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht.

Ethical Approval: The study was approved by the ethical review board MUMC+/Maastricht University [UM, NL number: 70787.068.19/METC number: 19-052] and complied with the Declaration of Helsinki. All participants gave written informed consent for use of their data.

Trial Registration: NCT04342312

Keywords: Atrial fibrillationExpiratory airflow limitationRepurposing pre-ablation work-upCardiac computed tomographic angiography