Integration of preprocedural computed tomography scan findings into atherosclerotic cardiovascular disease risk estimation in patients with atrial fibrillation scheduled for catheter ablation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) and atherosclerosis often coexist due to a shared risk profile. Prior to an AF ablation, computed tomography (CT) scans are routinely performed to assess pulmonary vein anatomy. Often coronary plaques are described as incidental findings. According to current guidelines, patients with coronary plaques on CT are classified as being at very high risk of developing cardiovascular atherosclerotic events, potentially resulting in a redefinition of treatment targets for comorbidities. Purpose This study estimated individual 10-year risks of developing atherosclerotic cardiovascular disease (CVD) events according to the 2021 ESC guideline on CVD prevention before and after the integration of CT-derived coronary plaque information in the risk assessment of AF patients scheduled for catheter ablation. Methods Consecutive AF patients scheduled for catheter ablation were included in the ISOLATION registry (NCT04342312). Patients were excluded from this subanalysis if no preprocedural CT was performed. Each patient was classified as being at low-to-moderate, high, or very high risk of developing CVD in the coming 10 years according to the 2021 ESC guideline on CVD prevention (Figure 1). This classification was based on previous CVD, chronic kidney disease, diabetes mellitus, or the Systematic Coronary Risk Estimation 2 (SCORE2) or SCORE2-Older Persons (SCORE2-OP) risk estimation. The impact of pre-AF ablation CTs on CVD risk was assessed by comparing risk classifications excluding and including information on coronary plaques on CT. Results A total of 1022 patients (age 64 ±9, 664 [65%] male, 686 [67%] paroxysmal AF) was included. Overall CVD risk was high, with 86% of patients at a high (n=190, 19%) or very high (n=693, 68%) 10-year risk of developing CVD events. Coronary plaques were observed in 59% (n=606) of pre-AF ablation CTs. Integration of the CT-derived information on coronary plaques resulted in reclassification of 364 patients (36%) towards the very high risk category (Figure 2). Previous CVD events were observed in 161 very high risk patients (16%). Conclusion In AF patients scheduled for catheter ablation, integration of the information on coronary plaques derived from the pre-AF ablation CT resulted in reclassification of one in three patients towards the very high risk category, which impacted treatment targets for lipid levels and blood pressure.