Assessment of coronary blood flow in patients with atrial fibrillation: VIRTU-AF (Mk2)

Normally the heart beats regularly, but as you get older it can become irregular. This is called atrial fibrillation (AF). It can commonly cause palpitations, breathlessness, chest pain and blood clots. It is a frequent cause of admission to hospital. About 10% of patients have it, and it is more common in the elderly. These patients often also have furred up blood vessels in the heart (coronary artery disease). It is difficult to work out if their symptoms are due to the irregular heartbeat or the furred-up arteries. We can treat both conditions, but opening up the arteries is invasive and can expose these patients to risk. It would be useful to work out who to treat. So we will study patients who come into hospital with a mild heart attack and AF. We will settle them down with tablets for their AF and (as long as it is not critical) their coronary artery disease. We will take pictures of their arteries (a coronary angiogram) to see how bad the ‘furring-up’ is and measure the blood flow through the arteries. Then, if the patients are better, we will stop and allow them home. If the patients are better, we will do no more. If they still have chest pain or breathlessness, we will bring them back to hospital and open up any narrowed arteries using balloons and stents (‘coronary angioplasty’; ‘percutaneous coronary intervention’ [PCI]). We will measure the blood flow after stenting, to investigate the degree of improvement in flow. This study will give us the information needed to design a large clinical trial to see whether treating the AF and associated conditions is more important than stenting the narrowed arteries using conventional measurements of blood flow. The primary endpoint will be the symptom burden six months after first presentation.