Abstract 15764: Family History of Atrial Fibrillation as a Predictor of Atrial Substrate and Outcomes in Patients Undergoing Atrial Fibrillation Catheter Ablation
Introduction: Atrial fibrillation (AF) is the most common dysrhythmia with numerous management strategies including catheter ablation. A commonly held notion is that patients with genetically predisposed AF have a different atrial substrate and therefore poorer outcomes.
Hypothesis: We sought to systemically characterize patients referred for AF ablation both with and without a family history (FH) of AF. Using a reported first degree family member with atrial fibrillation, we sought to determine if a FH of AF was associated with altered atrial substrate and/or ablation outcomes.
Methods: Consecutive patients with AF who presented for ablation were followed for at least 1 year. FH was extracted from the medical record, from at least two independent clinical documents, with the presence of one first degree relative with AF being categorized as a “positive FH”. We identified 123 patients with paroxysmal and 133 with persistent AF with corroborated FH. We identified clinical characteristics, electroanatomic map findings, ablation characteristics and arrhythmia outcomes for patients with and without a positive FH.
Results: Patients with paroxysmal AF with a positive FH (n=57; 46%) had similar clinical characteristics, mapping findings, ablation characteristics and follow up arrhythmia free survival as those without a positive FH (n=66; 54%). Conversely, patients with persistent AF with a positive FH (n=75; 56%) had similar characteristics, mapping findings and ablation characteristics, as those without a positive FH (n=58; 44%), but long term arrhythmia free survival was inferior in those with a positive FH of AF compared to those without [Hazard ratio = 1.76 (95% CI: 1.01, 3.08)].
Conclusions: The presence of a first degree family member with AF does not appear to impact the outcomes of pulmonary vein isolation for paroxysmal AF. In contradistinction, patients with a positive FH with persistent AF have inferior long term arrhythmia free survival that is not clearly explained by clinical characteristics, atrial substrate at the time of mapping or ablation characteristics. These findings suggest further work into the genetic aspects of persistent AF may benefit patient selection for ablation of AF.
Author Disclosures: S. Kapur: None. C.A. MacRae: None. G.F. Michaud: None.
- © 2016 by American Heart Association, Inc.