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

26 Pages Posted: 9 Aug 2023

See all articles by Maartje Hereijgers

Maartje Hereijgers

Maastricht University

Rachel van der Velden

Maastricht University

Nora el Moussaoui

Maastricht University

Dominique Verhaert

Maastricht University

Zarina Habibi

Maastricht University

Justin GLM Luermans

Maastricht University

Dennis den Uijl

Maastricht University

Sevasti-Maria Chaldoupi

Maastricht University

Kevin Vernooy

Maastricht University

Ulrich Schotten

Maastricht University - Cardiovascular Research Institute Maastricht (CARIM)

Mathias Baumert

University of Adelaide

Hester Gietema

Maastricht University

Casper Mihl

Maastricht University

Lukasz Koltowski

Medical University of Warsaw

Frits M.E. Franssen

Maastricht University

Sami Simons

Maastricht University

Dominik Linz

Maastricht University

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

Suggested Citation

Hereijgers, Maartje and van der Velden, Rachel and el Moussaoui, Nora and Verhaert, Dominique and Habibi, Zarina and Luermans, Justin GLM and den Uijl, Dennis and Chaldoupi, Sevasti-Maria and Vernooy, Kevin and Schotten, Ulrich and Baumert, Mathias and Gietema, Hester and Mihl, Casper and Koltowski, Lukasz and Franssen, Frits M.E. and Simons, Sami and Linz, Dominik, Repurposing Catheter Ablation Work-Up to Detect Expiratory Airflow Limitation in Patients with Atrial Fibrillation. Available at SSRN: https://ssrn.com/abstract=4527006 or http://dx.doi.org/10.2139/ssrn.4527006

Maartje Hereijgers

Maastricht University ( email )

Rachel Van der Velden

Maastricht University ( email )

Nora El Moussaoui

Maastricht University ( email )

P.O. Box 616
Maastricht, 6200MD
Netherlands

Dominique Verhaert

Maastricht University ( email )

Zarina Habibi

Maastricht University ( email )

P.O. Box 616
Maastricht, 6200MD
Netherlands

Justin GLM Luermans

Maastricht University ( email )

Dennis Den Uijl

Maastricht University ( email )

Sevasti-Maria Chaldoupi

Maastricht University ( email )

Kevin Vernooy

Maastricht University ( email )

Ulrich Schotten

Maastricht University - Cardiovascular Research Institute Maastricht (CARIM) ( email )

P.O. Box 616
Maastricht, Limburg 6200MD
Netherlands

Mathias Baumert

University of Adelaide ( email )

Hester Gietema

Maastricht University ( email )

Casper Mihl

Maastricht University ( email )

P.O. Box 616
Maastricht, Limburg 6200MD
Netherlands

Lukasz Koltowski

Medical University of Warsaw ( email )

Warsaw
Poland

Frits M.E. Franssen

Maastricht University ( email )

Sami Simons

Maastricht University ( email )

Dominik Linz (Contact Author)

Maastricht University ( email )

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