Atrial Fibrillation Cycle Length Is a Sole Independent Predictor of a Substrate for Consecutive Arrhythmias in Patients With Persistent Atrial Fibrillation

Abstract Background Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR. Purpose The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR. Methods We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial. On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination. Results Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p<0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004). Conclusions Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement. FUNDunding Acknowledgement Type of funding sources: None.

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Repetitive Evaluation of Fibrillation Cycle Length Predicts the Effect of Bepridil for Conversion of Long-Lasting Persistent Atrial Fibrillation to Sinus Rhythm

Journal of Arrhythmia ◽

10.4020/jhrs.27.op51_4 ◽

2011 ◽

Vol 27 (Supplement) ◽

pp. OP51_4

Author(s):

Yuya Aoyama ◽

Shinichi Niwano ◽

Hiroe Niwano ◽

Yoshihiro Yumoto ◽

Akira Sato ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Cycle Length ◽

Persistent Atrial Fibrillation

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Repetitive Evaluation of Fibrillation Cycle Length Predicts the Efficacy of Bepridil for Interruption of Long-Lasting Persistent Atrial Fibrillation

International Heart Journal ◽

10.1536/ihj.52.353 ◽

2011 ◽

Vol 52 (6) ◽

pp. 353-358 ◽

Cited By ~ 3

Author(s):

Yuya Aoyama ◽

Shinichi Niwano ◽

Hiroe Niwano ◽

Akira Satoh ◽

Jun Kishihara ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cycle Length ◽

Persistent Atrial Fibrillation

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P1934Fibrillation cycle length predicts recurrence after catheter ablation in patients with persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehy565.p1934 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

H Fukaya ◽

J Kishihara ◽

J Oikawa ◽

Y Arakawa ◽

R Nishinarita ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Cycle Length ◽

Persistent Atrial Fibrillation

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Abstract 17454: The Effect of Catheter Ablation on Coronary Sinus Cycle Length in Persistent Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.17454 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ghaith Zaatari ◽

Jorge Bohorquez ◽

Raul Mitrani ◽

Jason Ng ◽

Justin Ng ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Coronary Sinus ◽

Cycle Length ◽

Persistent Atrial Fibrillation ◽

Posterior Wall ◽

Quality Signals ◽

Before And After ◽

Ventricular Activation ◽

Ablation Success

Background: While pulmonary vein isolation (PVI) for treatment of persistent atrial fibrillation (PeAF) is successful in approximately 50%, acute termination of PeAF is rarely observed. Prolongation of cycle length (CL) by 10% is often utilized as an indicator of successful catheter ablation (CA). Objective: To evaluate coronary sinus (CS) cycle length (CL) before and after CA for PeAF. Methods: CA for PeAF was performed in 31 patients (24males, age 63±9 yrs, CHA2DS2-VASc 2.3±1.7, LVEF 49±10%) with PVI, with 4 (13%) also having posterior wall isolation. A multielectrode catheter was placed in the CS and maintained throughout the procedure. CS electrograms were recorded for 10 seconds prior to CA and after completion of CA. No patient reverted to sinus rhythm during CA. CS CL was determined using customized software for activation detection and verified visually, excluding ventricular activation and low quality signals (n=3). The shortest CL among the recording electrodes was used for analysis. Results: CS CL pre- and post-CA were 182.4±23.0 and 191.6± 29.9 ms (p= 0.04) with change from baseline of 5.4±12.7%. The figure shows the histogram for change in CS CL from baseline. Only 7/28 (25%) of patients had CS CL prolongation >10%. Of ten patients who were free of AF off anti-arrhythmic drugs at 1 year, CS CL increased 4.0±6.1%; 2/10 had CS CL prolongation >10%. Of 6 patients with recurrent AF, CS CL increased 13.8±20.7%; 4/6 had CS CL prolongation >10%. Conclusion: Our data demonstrate that CS CL prolongation >10% is not a useful marker of outcomes in patients undergoing catheter ablation for PeAF. This highlights the need to identify other indicators of acute ablation success.

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Abstract 16896: Electrogram Morphology Recurrence to Characterize Drivers of Persistent Atrial Fibrillation: Findings at Initial versus Redo Catheter Ablation

Circulation ◽

10.1161/circ.142.suppl_3.16896 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ghaith Zaatari ◽

Jorge Bohorquez ◽

Raul Mitrani ◽

Jason Ng ◽

Justin Ng ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Cycle Length ◽

Cross Correlation ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Success Rates ◽

Mapping Tool ◽

Group 2 ◽

Group 1

Background: Electrogram (EGM) morphology recurrence (EMR) mapping of persistent atrial fibrillation (PeAF) quantifies consistency of activation at each site and is expected to be high and rapid near drivers of PeAF. Objective: To compare EMR in the left (LA) and right atrium (RA) in patients undergoing first- vs second-time PeAF catheter ablation (CA). Methods: Multisite bipolar EGM mapping of the LA (265±153 sites) and RA (224±148 sites) prior to CA for PeAF was performed in 40 patients (29 males, age 63±9 yrs, CHA2DS2-VASc 2.4±1.5, LVEF 48±12%) undergoing first (Group 1, n=31) or second-time (Group 2, n=9) CA. After cross-correlation of each automatically detected EGM with every other EGM in the recording, the most recurrent EGM morphology was identified and its frequency (Rec%) and cycle length of recurrence (CL R ) were computed (figure). The minimum CL R sites were identified. Results: In group 1, shortest CL R was in the LA in 26 patients (84%) and RA in 5 patients (16%). In the LA, there were 1 (n=23), 2 (n=2), or 3 (n=1) areas of shortest CL R , most commonly in the pulmonary veins (PV; n=19). In the RA, there was only 1 area of shortest CL R . Minimum CL R was 174.1±25.4 ms (LA-179.6±37.4 vs RA-207.9±34.5, p=0.0004), with Rec% 95±10%. In group 2, shortest CL R was in the LA in 5 patients and RA in 5 patients (56%)– one had both LA and RA. In the LA/RA, there were 1 (n=3/4) or 2 (n=2/1) areas of shortest CL R . The most common LA site was non-PV (6/7, 85.7%). The minimum CL R was 182.1±26.2ms (LA-190.8±36.2 vs RA-196.0±30.5, p=0.6), with Rec% 96±5%. Conclusion: In 61% of patients undergoing initial CA for PeAF, EMR identified LA drivers in the PVs which may explain why PV isolation has been reported to have 50-60% success rates in PeAF. In patients undergoing a 2 nd ablation for PeAF, EMR identified predominantly nonPV drivers with even distribution of shortest CL R between RA and LA and diminished CL R gradient between the LA and RA. EMR may be a useful mapping tool to characterize potential drivers of PeAF.

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