title: Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls.
abstract: BACKGROUND
  Idiopathic atrial fibrillation (AF) refers to a clinically lacking cardiovascular or pulmonary disease generating the pathophysiologic substrate for the arrhythmia. However, because idiopathic AF is associated with an increased event rate, it could be a harbinger of as-yet undetected underlying heart disease.
  
  
  OBJECTIVE
  The purpose of this study was to determine the prevalence of coronary artery disease (CAD) in patients diagnosed with idiopathic paroxysmal AF.
  
  
  METHODS
  Of the 3243 patients who underwent cardiac computed tomographic angiography (CTA) in our center between January 2008 and March 2011, we identified a total of 115 consecutive idiopathic paroxysmal AF patients who underwent CTA before electrophysiologic ablation. Patients were compared with 275 age-, sex-, and PROCAM risk score-matched healthy controls in permanent sinus rhythm. All patients were free of hypertension, diabetes, congestive heart failure, previous known coronary artery and peripheral vascular disease, previous stroke, thyroid, pulmonary, and renal disease, and structural abnormalities on echocardiography.
  
  
  RESULTS
  Controls more often showed a family history of CAD (38% vs 15%, P <.001), had a higher prevalence of smoking (25% vs 14%, P = .021), higher fasting blood glucose levels (5.5 ± 0.7 mmol/L vs 5.4 ± 0.6 mmol/L, P = .025), and smaller atrial diameters (37 ± 4 mm vs 40 ± 5 mm, P <.001) compared to AF patients. Notwithstanding the above, idiopathic AF patients significantly more often suffered from subclinical CAD compared to controls (49% vs 34%, P = .008). Multivariable regression analysis revealed that beside (as expected) age and gender, a history of AF and left atrial diameter were significant predictors of underlying CAD.
  
  
  CONCLUSIONS
  Half of patients originally diagnosed with idiopathic paroxysmal AF show concealed underlying CAD. The detection and treatment of CAD at an early stage could improve the prognosis of these patients.
authors.affiliation: Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, The Netherlands. bobweijs@hotmail.com
authors.forename: Bob
authors.initials: B
authors.lastname: Weijs
authors.forename: Ron
authors.initials: R
authors.lastname: Pisters
authors.forename: Rutger J
authors.initials: RJ
authors.lastname: Haest
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Kragten
authors.forename: Ivo A
authors.initials: IA
authors.lastname: Joosen
authors.forename: Mathijs
authors.initials: M
authors.lastname: Versteylen
authors.forename: Carl C
authors.initials: CC
authors.lastname: Timmermans
authors.forename: Laurent
authors.initials: L
authors.lastname: Pison
authors.forename: Yuri
authors.initials: Y
authors.lastname: Blaauw
authors.forename: Leonard
authors.initials: L
authors.lastname: Hofstra
authors.forename: Robby
authors.initials: R
authors.lastname: Nieuwlaat
authors.forename: Joachim
authors.initials: J
authors.lastname: Wildberger
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Crijns
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012849:Sinoatrial Node / Q000502:physiology*; D014057:Tomography, X-Ray Computed