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Coronary Artery Calcification in Pre-Atrial Fibrillation Ablation Scans: A Missed Opportunity?

We read with great interest the recent article by Dunleavy et al. [1] describing the prevalence of coronary artery calcification (CAC) on pre-ablation computed tomography (CT) of the pulmonary veins (CTPV) in patients with atrial fibrillation (AF) in Ohio.Specifically, pre-ablation CT is performed as a non-gated high-pitch helical CT-scan with contrast timed for optimal pulmonary vein and left atrial opacification, followed by a 40-second delayed scan to more thoroughly evaluate the left atrial appendage for thrombus. However, the performance of pre-ablation CT-scans also offers in many patients an opportunity to identify subclinical coronary artery disease (CAD) and refine the intensity of preventive therapies. Thus, the frequency of CAC reporting on CTPV imaging, and its impact on statin prescriptions at time of hospital discharge was also investigated. The authors demonstrated that even though CAC is highly-prevalent in AF patients and is consistently reported on pre-ablation CTPV, its presence was not associated with increases in statin prescribing in eligible patients. Importantly, 34% of the studied cohort had known clinical CAD, a group in whom the presence and severity of CAC would not typically result in a change in management.

Credits: Harmon E, Allam S, Kutinsky I, Villines T, and Mehta N

Biosense Webster
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Introduction to AFib
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