Abstract 15639: Clinical Characteristics of Patients with Paroxysmal Lone Atrial Fibrillation not Requiring Additional Ablation In Addition to Pulmonary Veins Isolation to Achieve Long Term Freedom from Atrial Arrhythmias

Abstract

Introduction: Pulmonary vein (PV) isolation represents the gold standard ablation strategy in patients (pts) with paroxysmal lone atrial fibrillation (PAF). However in some cases in addition to PV isolation, ablation of non-PV trigger is necessary to achieve success. We sought to identify the clinical characteristics of pts with lone PAF where PV isolation alone was sufficient to achieve long term success.

Methods: 452 consecutive pts with lone PAF undergoing PV isolation extended to the posterior wall contained within the PVs composed our population. The presence of non-PV triggers was disclosed by high-dose isoproterenol challenge, and were defined as any consistent non-PV ectopic activity (≥10 premature atrial beats/min and/or atrial tachycardia/fibrillation/flutter).Non PV triggers were not ablated during the first procedure.Clinical characteristics and ablation outcomes were compared in pts with and without non-PV triggers.

Results: Non-PV triggers were present in 140 (31%) pts, and were most commonly mapped in the coronary sinus (61%), left atrial appendage (49%), interatrial septum (18%), and crista terminalis/superior vena cava (12%). Pts without non-PV triggers were younger (54 ± 10 vs. 64 ± 11 years, P < 0.001), less frequently females (22% vs 48%., P <0.001), with lower prevalence of comorbidities (diabetes: 5% vs.15%, P = 0.008; hypertension: 22% vs 51%, P <0.001; body mass index: 26 ± 5 vs 31 ± 6. Kg/m2, P = 0.005), and had shorter duration (<10 hours) of AF (P = 0.006). At a mean follow-up of 28 ± 9 months and with a single procedure, 291 (90%) pts without non-PV triggers were free from recurrent AF, compared to 30 (23%) of those with non-PV triggers (P <0.001). At the multivariate analysis presence of non-PV triggers (HR 4.10 (1.63-9.72), p=0.013) was the strongest predictor of recurrence after a single procedure.

Conclusions: Age <45 years, male gender, short AF duration, LA size <4.2cm, and absence of comorbidites identified patients without non PV triggers. In this subset of pts PV isolation achieve long term success with a single procedure.