Author + information
- Martin Vandaele,
- Marc Badoz,
- Benjamin Bonnet,
- Marion Chatot,
- Romain Chopard,
- Marie-France Seronde,
- Francois Schiele and
- Nicolas Meneveau
Background: Catheter ablation is the treatment of choice for the management of atrial fibrillation (AF). The main limitation of this technique is the success rate, which is in the range of 70 to 80%. It is therefore critical to identify patients likely to benefit from this procedure, and who will maintain a sinus rhythm. Left atrial pressure (LAP) affects the atrial wall and is therefore implicated in the genesis of AF. We aimed to evaluate the impact of LAP, measured at the beginning of the ablation procedure, on the rate of recurrence of AF at 3 months post-procedure.
Methods: All patients undergoing catheter ablation of AF in a single university teaching hospital between May 2014 and March 2016 were included in a prospective registry. LAP was measured at the time of transseptal puncture. Left atrial volume was measured retrospectively by a radiologist blinded to patient outcome from ECG-gated contrast enhanced CT scan. AF ablation was performed either by radiofrequency or by cryotherapy. All patients had a follow-up consultation 3 months post-procedure including 24-hour Holter ECG monitoring. Procedural success was defined as the absence of recurrent AF at 3 month follow-up. Cox logistic regression was used to identify predictors of recurrent AF.
Results: A total of 109 patients were included, procedural success rate was 79%. LAP was significantly higher in patients with recurrent AF than in those with procedural success (12.4±7 vs 7.7±4.5 mmHg, p=0.0003). The proportion of patients with LAP ≥15 mmHg was also significantly higher in patients with recurrent AF (38% vs 7%, p=0.0008). Multivariate analysis identified LAP ≥15 mmHg, left atrial volume >127 mL, persistent AF and thyroid dysfunction as predictors of recurrence of AF.
Conclusions: Our study shows that LAP ≥15 mmHg at the time of ablation was an independent predictor of recurrence of AF at 3 months. This could help to orient treatment towards complementary procedures and reinforced anti-arrhythmic and diuretic therapy.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1280-106
- 2017 American College of Cardiology Foundation