Herz-Kreislauf-Erkrankungen und Diagnose

Vasospastic Angina, Especially Involving Coronary Arteries Supplying Atria, is a Predictor for Atrial Fibrillation

Abstract

Myung-Jin Cha, You-Jeong Ki, Eue-Keun Choi and Seil Oh*

Background: Atrial ischemia is a known risk factor of non-valvular atrial fibrillation (AF). However, relationship between coronary vasospasm and AF has not yet been determined. Methods: We investigated consecutive patients with normal sinus rhythm without AF history who underwent coronary angiography with ergonovine provocation test to evaluate vasospastic angina (VA). Patients with spasms over 50% and either typical chest pain or electrocardiogram changes during provocation test were diagnosed as vasospastic angina (VA group). Results: Out of total 683 patients investigated, nine (4.6%) patients in VA group (n=195) and seven (1.4%) patients in control group (n=488) developed new-onset AF (follow-up duration, median 56 months; range, 6-263 months). Annual AF incidence rate was higher in VA group (0.63%/y) than in control group (0.23%/y). In univariate and multivariate analysis adjusted for age, VA was an independent predictor of AF (HR 2.93, p=0.021). In subgroup analysis of 195 patients with VA, there were no cases of AF in patients with spasm observed only in the left anterior descending artery. All nine patients with new onset AF had spasm in the right coronary artery or left circumflex artery. Conclusions: Vasospastic angina could be an independent predictor of new-onset AF.