Abstract 17287: Difference in the Maintenance Mechanism Between the Paroxysmal and Persistent Atrial Fibrillation: Three-dimensional Analysis Using a Non-contact Mapping System
Introduction: Pulmonary vein isolation has been effective in the treatment of paroxysmal atrial fibrillation (AF). However, ablation response rate remains lower in persistent AF. Furthermore, the difference in the maintenance mechanism remains unclear.
Hypothesis: The purpose of this study was to elucidate the difference in the activation of AF between paroxysmal and persistent.
Methods: Endocardial mapping of the left atrium was performed in 28 AF patients (14 paroxysmal and 14 persistent AF) using a non-contact mapping system (EnSite 3000) during AF. The difference in the number of rotor, pivoting activation, wave break and fusion between the paroxysmal and persistent AF were analyzed. To define the significance of rotor for AF maintenance, the number of pivoting activations involved in the rotor was compared with that not involved in the rotor. Presence of rotor was defined when the circular activation around the functional block line once completed its whole reentrant activation.
Results: Rotor was observed in 12 paroxysmal AF (86%) and 11 persistent AF (79%) (p=NS). There was no significant difference in the number of rotor between paroxysmal and persistent AF (1.8±1.2 vs. 1.5±1.2 times/sec, p=NS). However, the number of pivoting activation, wave break and fusion in paroxysmal AF were significantly lower than those in persistent AF (12.5±4.0 vs. 18.8±6.5 times/sec, p=0.006, 5.4±2.4 vs. 8.3±3.3 times/sec, p=0.012, and 2.9±1.5 vs. 4.6±2.3 times/sec, p=0.025, respectively). The number of pivoting activation involved in the rotor was significantly lower than that not involved in the rotor both in paroxysmal AF (3.6±2.7 vs. 7.6±5.3 times/sec, p=0.018) and persistent AF (3.7±3.3 vs. 15.1±5.5 times/sec, p<0.01). Furthermore, the number of pivoting activations not involved in the rotor in paroxysmal AF was significantly lower than that in persistent AF (p=0.001).
Conclusions: The activation sequence in persistent AF is more disorganized than in paroxysmal AF, associated with much more frequent episodes of pivoting activation, wave break and fusion in persistent AF. However, most of pivoting activations were not involved in the rotor both in paroxysmal and persistent AF, suggesting that AF was driven by non-rotor disorganized activations.
Author Disclosures: S. Kaneko: None. H. Yamabe: Other Research Support; Modest; Medtronic Japan, Nihon Kohden, Boston scientific, St Jude Medical, Japan Lifeline, Fukuda Denshi, Neotec Japan, Shionogi. H. Kanazawa: Other Research Support; Modest; Medtronic Japan, Nihon Kohden, Boston scientific, St Jude Medical, Japan Lifeline, Fukuda Denshi, Neotec Japan, Shionogi.. M. Ito: None. Y. Kanemaru: None. T. Kiyama: None. H. Ogawa: Other Research Support; Modest; Eisai Co.,Ltd.. Other Research Support; Significant; Abbott Vascular Jaoan, Bayer Yakuhin, Ltd., Boehringer Ingelheim Japan, Boston Scientific Japan K.K., Chugai Pharmaceutical Co.,Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Fuk. Honoraria; Modest; AstraZeneca K.K, Eisai Co.,Ltd, Otsuka Pharmaceutical Co, Ltd, Takeda Pharmaceutical Co., Ltd, Teijin Pharma Co., Ltd.. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., MSD K.K..
- © 2016 by American Heart Association, Inc.