Early temporal and spatial regularization of persistent atrial fibrillation predicts termination and arrhythmia-free outcome

Abstract

Background Termination of persistent atrial fibrillation (AF) is a valuable ablation endpoint, but is difficult to anticipate. We evaluated whether temporal and spatial indices of AF regularization predict intra-procedural AF termination and outcome. Objective To test whether temporospatial organization of AF after pulmonary vein isolation (PVI) predicts whether subsequent stepwise ablation will terminate persistent AF or predict outcome. Methods In 75 patients with persistent AF, we measured AF cycle length (AFCL), temporal regularity index (TRI, a spectral measure of timing regularity) and spatial regularity index (SRI, cycle-to-cycle variations in spatial vector) between right atrial appendage, proximal and distal coronary sinus before and during stepwise ablation to the endpoint of AF termination. Results AF termination was achieved in 59 patients (79%) by ablation. AF terminated during PVI in 11 patients, who were excluded from analysis. In the remaining 48 patients, TRI and SRI increased during stepwise ablation, as compared to 16 patients without termination (p < 0.05). AFCL prolonged in both groups. From ROC analysis of the first 22 patients (training set), a post-PVI TRI increase predicted AF termination in the latter 42 patients (test set) with PPV 96 %, NPV 53 %, sensitivity 71 % and specificity 91 %. Results were similar for SRI. After 36 months, higher arrhythmia-free outcome was observed in patients in whom PVI caused temporospatial regularization in AF. Conclusions Temporal and spatial regularization of persistent AF after PVI identifies patients in whom stepwise ablation subsequently terminates AF and prevents recurrence.

Prognostic Role of Subsequent Atrial Tachycardias Occurring During Ablation of Persistent Atrial Fibrillation

“…3,4,9,15,16 Conversion of AF to AT characteristically occurs after an arrhythmia organization, which is represented by a continuous increase of the AFCL up to a critical level ≈200 ms. 3,4,13,16,17 The mechanisms and antiarrhythmic processes by which electrogram-guided ablation of AF results in arrhythmia organization yet are still not completely clear and are a critical matters of discussion. Recently, 2 different new computational mapping techniques have been introduced to map and ablate more specifically the arrhythmia-perpetuating atrial substrate of persistent AF.…”

Impact of catheter ablation with remote magnetic navigation on procedural outcomes in patients with persistent and long-standing persistent atrial fibrillation

“…Termination of AF is associated with longer maintenance of sinus rhythm (SR) after ablation regardless of whether AF is restored to SR or converted to atrial tachycardia (AT) during catheter ablation [6,7]. Pre-ablation factors, such as left atrial (LA) diameter or volume, duration of AF, AF cycle length (AFCL), and wave amplitude, have been shown to predict the likelihood of termination during manual catheter ablation in patients with PsAF and L-PsAF [6,8,9].…”

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In these studies, both increased single procedural success 3,5,8,10,[13][14][15][16]19,21 and overall clinical success with multiple procedures 2,6,7,[11][12][13][15][16][17]20,21 were reported when compared with patients who did not achieve AF termination. In a study by Rostock et al, 22 which evaluated the long-term predictors of single-and multiple-procedure outcomes for 395 patients who had undergone persistent AF ablation, AF termination during the index procedure significantly predicted single-procedure success and also a favorable outcome after the final procedure.…”