Author + information
- Shimaa Khidr,
- Mark Doyle,
- Geetha Rayarao and
- Robert Biederman
Background: Since Haissaguerre demonstrated the key role of pulmonary veins (PV's) in initiation and propagation of AF in 1998, the idea of PV isolation (PVI) has become ubiquitous. However, there is an unacceptable recurrence rate that remains elusive. Despite considerable research on PVI, very few have directly investigated the role of the pulmonary veins themselves albeit the PV's being the main ablation target.
Hypothesis: We propose to: 1) interrogate the PV conditions pre and post PVI. 2) demonstrate if PV conditions in the pre PVI state can potentially serve as a clinical marker for NSR maintenance.
Methods: We evaluated 100 patients with AF who had CMR before and 6±2 months after PVI. Each PV cross sectional areas (CSA) and LA volume were triangulated and measured from the 3D MRA of the LA PV's within 1cm of the ostium. Patients were classified as responders (R) based on two 15-day Holter monitors if they had none or < 1 minute of AF during monitoring period and non-responders (NR) if otherwise.
Results: 100 pts (71% M) were followed with 74 (74%) classified as responders. Demographic data were similar between groups. There was no significant difference between average PV CSA at baseline between R and NR (233±53 vs 241±54 cm2 p=0.5). Reduction in CSA occurred significantly in both groups in R (233±53 to 192±52 cm2, p<0.001) and NR (241±54 to 207±44 cm2, p<0.001). Yet, the difference between R and NR in the post conditions was still not significant (192±52x to 207± 44 cm2, p=0.19). The average reduction in the PV's CSA moderately correlated with that of the LA (r = 0.48, p <0.001). The following pre procedural PV conditions were studied with regard to NSR prediction: 1) individual and average CSA of the 4 main PVs, 2) standard deviation, 3) the coefficient of variation 4) it's inverse 5) maximum vein CSA 6) minimum vein CSA 7) absolute and 8) the percentage of change before vs. after PVI, however, no metric correlated with long term maintenance of NSR.
Conclusions: PV's undergo significant reverse remodeling irrespective to the patient's outcome. Although they moderately correlate with the reduction in the LA volume, despite high clinical likelihood, they counterintuitively completely fail to predict maintenance of NSR.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Basic 5
Abstract Category: 4. Arrhythmias and Clinical EP: Basic
Presentation Number: 1281-116
- 2017 American College of Cardiology Foundation