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Atrial fibrillation cycle length as a predictor for the extent of substrate ablation
Ho-Chuen Yuen1, Seung-Young Roh2, Dae-In Lee2
1Korea University Anam Hospital, Seoul, Korea johnny_yuen50@hotmail.com.
Insights
Mean atrial fibrillation (AF) cycle length (CL) predicts ablation success and recurrence risk. Shorter AF CL indicates less extensive ablation is needed, improving outcomes. The RA to LA AF CL gradient does not predict the need for additional RA ablation.
Area of Science:
- Electrophysiology
- Cardiac Arrhythmias
- Catheter Ablation
Background:
- Atrial fibrillation (AF) cycle length (CL) is a known predictor of ablation success.
- Understanding AF CL gradients between atria may refine ablation strategies.
Purpose of the Study:
- To evaluate the predictive value of the atrial fibrillation cycle length (AF CL) gradient between the right atrium (RA) and left atrium (LA) and their mean AF CL in determining the extent of substrate ablation required for AF termination.
- To assess the correlation between AF CL parameters and ablation outcomes, including termination success and arrhythmia recurrence.
Main Methods:
- A prospective study of 136 patients undergoing first ablation for persistent AF.
- Stepwise ablation was performed sequentially: pulmonary veins (PV), LA, then RA, aiming for AF termination.
- AF CL was measured in the RA and LA, and mean AF CL was calculated.
Main Results:
- AF terminated in 81% of patients. Mean AF CL was significantly shorter in patients requiring more extensive ablation (Group R: RA+LA+PV vs. Group L: LA+PV vs. Group P: PV only).
- Mean AF CL >180.50 ms predicted PVI-only termination (79% sensitivity, 84% specificity). Mean AF CL >165.25 ms predicted left-side ablation termination (67% sensitivity, 75% specificity).
- Freedom from recurrence was higher with left-side ablation (Groups P+L) compared to additional RA ablation (Group R) (P=0.024). The RA to LA AF CL gradient did not predict the need for RA ablation (P=0.177).
Conclusions:
- Baseline mean AF CL can identify patients likely to achieve AF termination with varying degrees of substrate ablation, potentially predicting recurrence risk.
- The RA to LA AF CL gradient is not a reliable predictor for the necessity of additional RA ablation during AF ablation procedures.
Aims:
Atrial fibrillation (AF) cycle length (CL) has been demonstrated to be one of the predictors for termination during ablation for AF. We evaluated the AF CL gradient between right atrium (RA) and left atrium (LA) and their mean AF CL in predicting the extent of substrate ablation.
Methods And Results:
One-hundred and thirty-six patients undergoing first ablation for persistent AF were studied. Stepwise ablation, sequentially in the following order: pulmonary veins (PV), LA, and RA, was performed to achieve AF termination. Stepwise ablation terminated AF in 110 patients (81%). In the AF termination group, AF was terminated by PV isolation (PVI) (Group P), PVI plus LA ablation (Group L), and PVI plus LA plus RA ablation (Group R) in 14 patients (13%), 49 patients (44%), and 47 patients (43%), respectively. Group R had much shorter mean AF CL than Group L (156 ± 18 vs. 174 ± 24 ms, P < 0.001) and mean AF CL in Group L was much shorter than Group P (174 ± 24 vs. 209 ± 36 ms, P = 0.004). The RA to LA AF CL gradient was not significantly different between left-side ablation (Group P + Group L) and additional RA ablation (Group R) (P = 0.177). Mean AF CL >180.50 ms predicted AF termination by PVI (Group P) with 79% sensitivity and 84% specificity while mean AF CL >165.25 ms predicted AF termination by left-side ablation (Group P + Group L) with 67% sensitivity and 75% specificity. After a mean follow-up of 15 ± 7 months, freedom from arrhythmia recurrence was significantly higher in left-side ablation (Group P + Group L) than additional RA ablation (Group R) (P = 0.024).
Conclusion:
Baseline mean AF CL may identify the subset of patients in whom persistent AF can be terminated by different extent of substrate ablation, which may in turn predict the chance of recurrence. However, baseline RA to LA AF CL gradient cannot predict the need for additional RA ablation.
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