Abstract 14633: Longer Period of Atrial Fibrillation Persistence was Associated with Higher Prevalence of Triggers from the Non-Pulmonary Vein Foci
Background: The recurrence rate of atrial fibrillation (AF) is relatively high after catheter ablation (CA) for long-lasting persistent AF (LLAF), because of the advanced AF substrate in atria. We assessed the possibility that the progression of AF trigger was also the cause of higher recurrence rate.
Method; Consecutive 263 patients who underwent CA to persistent AF (PeAF) were included in this study. Patients were divided into 2 groups based on the period AF persisted; PeAF-group (persisted < 1 year, n=132) and LLAF-group (persisted ≥ 1 year, n=131). Cardioversion were performed before procedure to determine the presence or absence of AF-Triggers, defined as atrial premature contraction initiating AF recurrence within 90 seconds after restoration of sinus rhythm (SR) reproducibly. We repeated cardioversion to distinguish AF-Triggers from pulmonary vein (PV AF-Triggers) and those from non-pulmonary vein (Non-PV AF-Triggers). We performed average 1.3 ± 0.5 sessions of CA, followed them for 20 ± 11 months and checked the recurrence rate of AF based on ECG at the last hospital visit.
Result: The prevalence of AF-Triggers was almost same in these groups (LLAF-group vs. PeAF-group, 26.7% vs. 26.5%, p=0.97). However, the prevalence of PV AF-Triggers was significantly higher in PeAF-group (31% vs. 94%, p=0.012). To the contrary, the prevalence of Non-PV AF Triggers was significantly higher in LLAF-group (51% vs. 14%, p=0.0019). Though successful ablation of AF-Triggers were highly associated with success in maintenance of sinus rhythm (OR=16.3, p<0.0001), ablation of Non-PV AF-Triggers was succeeded only in 7 out of 23 patients, and the success rate was significantly lower than that of PV AF-Triggers (30% vs. 100%, p<0.0001). As a result, AF recurrence rate was significantly higher in LLAF-group than in PeAF-group (34% vs. 9%, p<0.018). In patients with successful AF-Trigger ablation, the recurrence rate in LLAF-group was relatively low and similar to that in PeAF-group (16% vs. 6%, p=0.66).
Conclusion: The progression of AF trigger from Non-PV foci was also the cause of the higher recurrence rate after CA for LLAF.
- © 2011 by American Heart Association, Inc.