Predictors of obstructive coronary artery disease in otherwise ‘healthy’ individuals with ST-segment depression during paroxysms of atrial fibrillation

Abstract

Paroxysmal atrial fibrillation Coronary artery disease Intima-media thickness C-reactive protein Ischemic ST-segment depression only during paroxysms of atrial fibrillation (AF), while the ECG appears unremarkable or non-specific during sinus rhythm, is not uncommon. This presentation is usually considered as a positive stress-test equivalent. However, we [1] and other investigators [2] have recently shown that in subjects without a history of cardiac disease, the presence of transient ischemic ECG changes during a paroxysm of AF, is not strongly associated with occult obstructive coronary artery disease (CAD). The present study aimed to investigate whether certain clinical factors or biochemical variables could predict the presence of underlying severe CAD in otherwise healthy individuals, who present with transient ischemic-type ST-depression only during AF, and have no evidence of profound structural heart disease or a concomitant acute cardiopulmonary event. Weassessedconsecutivepatientsolderthan40yearswhopresented to the emergency department with AF of recent onset (paroxysmal AF or persistent AF with duration of less than 30 days) and concomitant ischemic ST-segment depression. Ischemic ST-segment changes were defined according to exercise testing standards [3] .P atients with a history of CAD, other cardiac disοrders or severe co-morbidities were excluded from the study. Those who had biochemical and/or echocardiographic findings indicating an acute cardiopulmonary event or structural heart disorder were also excluded. Conversion to sinus rhythm was attempted in all admitted patients, either pharmaceutically or by synchronised transthoracic cardioversion, unless AF terminated spontaneously. Cardioverted patients with persistent ST-segment depression of more than 48h and patients in whom cardioversion was unsuccessful, were excluded. Patients who fulfilled all entry criteria and consented to the study protocol underwent the following investigations: