Abstract 2231: Multiple Arrhythmogenic Foci Are Associated with the Development to the Perpetuation of Atrial Fibrillation
Backgrounds; Presence of multiple arrhythmogenic sources may be associated with the perpetuation of atrial fibrillation (AF) because of its increased atrial electrical instability. In this study, we investigated whether the presence of multiple foci is associated with the development of the AF perpetuation.
Method; Consecutive 214 patients with AF undergoing catheter ablation were enrolled in this study (mean age; 61, Male; 120, persistent 44, AF period 58 months). Patients were divided into two groups; paroxysmal (n = 170) and persistent AF (n = 44). We determined arrhythmogenic foci baseline and after isoproterenol infusion (up to 20 mcg /min) in non-sedation state. To detect the foci, we used multipolar catheters, which were simultaneously located in left superior PV, left inferior PV, right superior PV, coronary sinus, superior vena cava, and crista terminalis. .
Results; We detected 500 arrhythmogenic foci. 263 foci (53%) in 174 patients (82%) were confirmed as AF initiator, and 237 AFC (47%) in 150 patients (70%) were reproductive premature beats with interval of < 350 ms or frequent repetitive firing. Duration of AF, left atrial and ventricular dimensions and the prevalence of structural heart disease were comparable between paroxysmal and persistent groups. Persistent group showed the higher incidence of non-PV foci than paroxysmal group (61% vs. 45%, p < 0.05), but the incidence of PV foci was comparable (93% vs. 89%). The incidence of multiple (≥ 2) foci (84 % vs. 65%, p < 0.05) and foci in the right atrium (55 % vs. 28%, p < 0.05) were higher in persistent group. Multivariate analysis demonstrated that multiple (≥ 2) foci was independent contributing factors for the persistent AF (Odds ratio; 95% CI, 4.9; 2.2–11.1, p < 0.01). In paroxysmal group, number of foci was higher in patients with long AF (> 24 hours) than those with short AF (2.6 vs. 1.8, p < 0.05). In persistent group, patients with short-lasting AF (< 12 months) had greater number of foci than those with long-term AF (> 12 months) (3.6 vs. 2.0, p < 0.05).
Conclusions; 1) Multiple non-PV foci are likely to be involved in the development of AF persistency. 2) However, if AF persisted for > 12 months, number of foci may decrease and may not be significant for AF perpetuation.