ABSTRACT
PURPOSE: Incident atrial fibrillation (AF) is common after cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) ablation. Risk factors for the development of AF post ablation are not well understood. The purpose of this study was to identify patients undergoing CTI ablation for AFL most likely to develop AF. METHODS: Retrospective chart review identified 114 consecutive patients without a history of AF or prior cardiac surgery who underwent typical CTI dependent AFL ablation between December 2013 to November 2018, who also had a complete preoperative transthoracic echocardiogram, and at least 1 year of follow-up at our medical center. We evaluated baseline characteristics, electrophysiology study (EPS) data and echocardiographic data for incidence of AF within 3 years. RESULTS: Incident AF was identified in 46 patients (40%) during 600 + 405 days follow-up. Left atrial volume index (LAVI) was significantly greater in patients who developed AF compared to those that did not (37 ± 12.2 ml/m2 vs 30 ± 13.4 ml/m2, p=.004), with an area under the receiver operator characteristic curve based on the LAVI of 0.7 (p = 0.004). Kaplan-Meier estimated incidence of AF was significantly greater in patients with LAVI ≥ 30 ml/m2 than LAVI < 30 ml/m2 (66% vs 27%, p=0.004). Risk of incident AF in patients with LAVI > 40 mL/m2 was similar to that of LAVI 30-40 ml/m2 (67% vs 63%, respectively, p=0.97). In multivariable analysis LAVI remained the sole independent predictor of incidence AF after CTI AFL ablation. CONCLUSIONS: LAVI ≥ 30 ml/m2 is associated with significantly increased risk of incident AF following CTI ablation for typical AFL. HATCH <2 was notably not an independent predictor of AF after AFL ablation.
ABSTRACT
BACKGROUND: Improved catheter stability is associated with decreased arrhythmia recurrence after atrial fibrillation (AF) ablation. Recently, atrial voltage mapping in AF was demonstrated to correlate better with scar as compared to mapping in sinus rhythm (SR). However, it is unknown whether ablation of persistent AF in sinus rhythm with atrial pacing or in atrial fibrillation with ventricular pacing results in differences in catheter stability or arrhythmia recurrence. METHODS: We analyzed 53 consecutive patients undergoing first-time persistent AF ablation with pulmonary vein and posterior wall isolation: 27 were cardioverted, mapped, and ablated in sinus rhythm with atrial pacing, and 26 were mapped and ablated in AF with ventricular pacing. Ablation data was extracted from the mapping system and analyzed using custom MATLAB software to determine high-frequency (60Hz) catheter excursion as a novel metric for catheter spatial stability. RESULTS: There was no difference in catheter stability as assessed by maximal catheter excursion, mean catheter excursion, or contact force variability between the atrial-paced and ventricular-paced patients. Ventricular-paced patients had significantly greater mean contact force as compared to atrial-paced patients. Contact-force variability demonstrated poor correlation with catheter excursion. One year arrhythmia-free survival was similar between the atrial paced and ventricular paced patients. CONCLUSIONS: For patients with persistent AF, ablation in AF with ventricular pacing results in similar catheter stability and arrhythmia recurrence as compared to cardioversion and ablation in sinus rhythm with atrial pacing. Given the improved fidelity of mapping in AF, mapping and ablating during AF with ventricular pacing may be preferred.
