Coronary Computed Tomography AngioGraphy Prior to Catheter Ablation in Patients With Atrial FIBrillation (FIBCAG)

Coronary Computed Tomography AngioGraphy Prior to Catheter Ablation in Patients With Atrial FIBrillation

Coronary Computed Tomography AngioGraphy Prior to Catheter Ablation in Patients With Atrial FIBrillation

The purpose of this randomized, controlled trial is to investigate whether coronary computed tomography (CT) angiography and derived treatment (medical anti-ischemic and multimodality treatment and/or mechanical revascularization) prior to catheter ablation improve clinical outcomes in patients with atrial fibrillation.

The study is an investigator-initiated, prospective, randomized, unblinded, controlled trial to investigate whether coronary CT angiography and derived treatment prior to catheter ablation improve clinical outcomes in patients with atrial fibrillation. The study population will consist of approximately 852 patients aged 18 years and above referred for a catheter ablation treatment for atrial fibrillation at Gentofte Hospital in Denmark. All participants included in the study will have a coronary CT angiography and coronary artery calcium (CAC) scoring performed as an amendment to the standard CT scan of the heart for mapping of the atria prior to catheter ablation. The participants are randomized 1:1 to either have the coronary CT angiography analyzed or not prior to the catheter ablation. According to the results of the coronary CT angiography in the intervention group, subsequent actions may include intensified multimodality medical treatment or referral to invasive coronary angiography and possibly mechanical revascularization according to clinical guidelines. The study will be completed when each patient has been followed for at least 1 year. The primary endpoint is time to first documented recurrence of atrial tachyarrhythmia lasting >30 seconds between 91 days after ablation and end of follow-up.

Coronary Artery Disease, Coronary Computed Tomography Angiography, Atrial Fibrillation, Ischemic heart disease, Catheter Ablation, Atherosclerosis, Cardiovascular Diseases, Randomized Controlled Trial, Statins

Based on the results of the coronary CT angiography and CAC scoring in the intervention group, relevant anti-ischemic and multimodality treatment will be initiated according to clinical guidelines.

Analysis of coronary CT angiography and CAC scoring and derived treatment prior to catheter ablation.

Between-group difference in time to first recurrence of atrial tachyarrhythmia lasting >30 seconds between 91 days after ablation and end of follow-up.

Between-group difference in the number of participants hospitalized for angina pectoris and acute coronary syndrome after ablation

Between-group difference in the number of patients undergoing revascularization procedures after ablation

Between-group difference in incidence of heart failure or heart failure hospitalization after ablation

Between-group difference in number of participants hospitalized for atrial fibrillation after ablation

Between-group difference in the prevalence of coronary artery disease in patients with atrial fibrillation at baseline

Between group difference in the quality of life of participants as quantified by a validated self-administered questionnaire

The proportion of participants in the active arm that are started or intensified on the following medication following the coronary CT angiography: statins, antithrombotic or antidiabetic medication

Between-group differences in the proportion of patients that are started or intensified on the following medication within 1 year after the coronary CT angiography: statins, antithrombotic, antidiabetic, or antihypertensive medication.

Between-group difference in the number of patients compliant with their prescribed medication 1 and 2 years after the coronary CT angiography as assessed based on a self-administered questionnaire

Inclusion Criteria: Age over 18 years Referral for catheter ablation treatment (excluding AV-junction ablation) for atrial fibrillation (all types of atrial fibrillation are included - paroxysmal, persistent, long-term persistent and permanent) at the Department of Cardiology at Gentofte Hospital. Both first ablation and re-ablation treatments are included. The ability and willingness to provide written informed consent Exclusion Criteria: Known atherosclerotic cardiovascular disease (ASCVD) Ongoing treatment with statins Contraindications for coronary CT angiography, e.g. contrast allergy Any surgical or medical condition, which in the opinion of the investigator, may place the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study.

Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte

Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte