Abstract 15752: Coarse Appearance of Atrial Fibrillation Associated With Greater Percentage of Low Left Atrial Voltage and Higher Post-ablation Arrhythmia Recurrence
Introduction: Atrial fibrillation (AF) is the most common clinical dysrhythmia, however our understanding of various subtypes of this umbrella diagnosis remain limited. One readily apparent categorizing variable is the appearance of fibrillatory waves on the surface electrocardiogram which classically divides AF into fine or coarse. The mechanistic underpinnings and clinical implications of this distinction remain unclear.
Hypothesis: We aimed to determine the natural history, the electroanatomic underpinnings and ablation implications of fine versus coarse AF.
Methods: We searched the Partners Healthcare system for patients with a diagnosis of long-standing persistent AF who had follow up electrocardiography and clinical evaluation. After excluding patients who were treated with catheter ablation, anti-arrhythmic therapy or underwent cardiac surgery, we identified a 135 patient cohort. We subsequently evaluated a separate cohort of patients with coarse (n=40) as well as fine (n=40) persistent AF referred for electroanatomic mapping and ablation and identified mapping findings, ablation characteristics and follow up outcomes. Fine versus coarse was classified based on surface EKG V1 fibrillatory wave amplitude.
Results: Patients with fine persistent AF at baseline were older (75 ± 13 vs 68 ±14 years; p = 0.04), while patients with coarse persistent AF were more likely to have hypertension, congestive heart failure, and valvular heart disease. Over an average follow up of 4.2 years, fine AF progressed to coarse AF in 25% of patients whereas coarse AF progressed to fine AF in 33% of patients. At the time of electroanatomic mapping, patients with coarse AF had increased percentage of low left atrial voltage (bipolar voltage ≤ 0.5 mV) (24± 8 % vs 8 ± 4 %; p = 0.01). Long term arrhythmia free survival was inferior in patients with coarse AF post ablation when compared to fine AF (Hazard ratio 1.83; p = 0.04).
Conclusions: The surface electrocardiographic appearance of coarse versus fine AF may represent distinct left atrial low voltage electrophysiology. Further evaluation is necessary to determine if this distinction can provide clinical insights that would alter patient care.
Author Disclosures: S. Kapur: None. C.A. MacRae: None. G.F. Michaud: None.
- © 2016 by American Heart Association, Inc.