Abstract 15320: Prevalence of Right Atrial Non-pulmonary Vein Triggers in Atrial Fibrillation Patients Treated With Thyroid Hormone Replacement Therapy
Introduction: Thyroid hormone is known to enhance the arrhythmogenicity of the pulmonary vein cardiomyocytes by increasing automaticity and triggered activity. Patients with high-normal thyroid function have been reported to be at an increased risk of AF recurrence after catheter ablation. However, very little is known about the impact of thyroid hormone replacement therapy on AF ablation. This study aimed to assess the effect of supplemental thyroid hormone on clinical parameters during catheter ablation in AF patients.
Methods: This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on thyroid hormone and 1003 (86%) without] undergoing their first catheter ablation at our institution. Propensity matching, based on scores calculated using a logistic model on the basis of baseline risk factors, generated 146 patients on thyroid hormone replacement (THR) therapy (65±10 year age, female 60%, BMI 30±7, LA size 44.3±0.8 mm) and 146 patients not receiving any thyroid hormone (control group; 65±9 year age, female 60%, BMI 30±7, LA size 4.3±1.1 mm). The presence of non-PV triggers was disclosed by high-dose isoproterenol challenge.
Results: Clinical characteristics were not different between the groups. Compared to the control group, non-PV triggers were significantly more prevalent in THR patients [112(77%) vs. 47 (32%), p<0.001]. These most frequently originated from the right atrium in THR group (95% in THR vs. 56% in control group, p<0.001). Other sources of non-PV triggers were, interatrial septum (25% vs. 11%, p=0.002), coronary sinus (70% vs. 52%, p=0.01), left atrial appendage (47% vs. 34%, p=0.03), crista terminalis/superior vena cava (11% vs. 8%, p=0.43), and mitral valve annulus (7% vs. 5%, p=0.45) in THR and control groups respectively.
Conclusion: Right atrial non-pulmonary vein triggers were more prevalent in AF patients treated with thyroid hormone compared to their counterparts. Our results strongly suggest the importance of personalization of the ablation strategy with identification and elimination of non-PV triggers to enhance the efficacy of ablation in AF patients on thyroid hormone replacement therapy.
Author Disclosures: S. Mohanty: None. P. Mohanty: None. L. Di Biase: Consultant/Advisory Board; Modest; Biosense Webster, Hansen Medical, St. Jude Medical. C. Trivedi: None. P. Santangeli: None. R. Bai: None. A. Al-Ahmad: None. J.D. Burkhardt: None. J.G. Gallinghouse: None. R. Horton: None. J. Sanchez: None. S. Bailey: None. P. Hranitzky: None. J. Zagrodzky: None. A. Natale: Honoraria; Modest; Biosense Webster, Janssen, Boston Scientific, Medtronic, St. Jude Medical.
- © 2014 by American Heart Association, Inc.