AI Article Synopsis
- A study was conducted to investigate the mechanisms of persistent atrial fibrillation (AF) using electrocardiographic imaging (ECGI) to see if these mechanisms can predict long-term success after pulmonary vein isolation (PVI).
- The trial involved patients with persistent AF receiving cryoballoon PVI, measuring potential drivers of AF and their impact on staying free from arrhythmia one year post-procedure.
- Results showed no significant link between the identified AF mechanisms and the likelihood of remaining in sinus rhythm, suggesting the need for further research with different approaches to understand AF better.
Article Abstract
Background: This prospective trial sought to phenotype persistent atrial fibrillation (AF) based on AF mechanisms using electrocardiographic imaging (ECGI) mapping to determine whether this would predict long-term freedom from arrhythmia after pulmonary vein isolation (PVI).
Methods: Patients with persistent AF of <2 years duration underwent cryoballoon PVI. ECGI mapping was performed before PVI to determine potential drivers (PDs) defined as rotational activations completing ≥1.5 revolutions or focal activations. The coprimary endpoint was the association between (1) PD burden (defined as the number of PD occurrences) and (2) PD distribution (defined as the number of segments on an 18-segment model of the atria harboring PDs) with freedom from arrhythmia at 1-year follow up.
Results: Of 100 patients, 97 completed follow up and 52 (53.6%) remained in sinus rhythm off antiarrhythmic drugs. Neither PD burden nor PD distribution predicted freedom from arrhythmia (hazard ratio [HR]: 1.01, 95% confidence interval [CI]: 0.99-1.03, p = .164; and HR: 1.04, 95% CI: 0.91-1.17, p = .591, respectively). Otherwise, the burden of rotational PDs, rotational stability, and the burden of PDs occurring at the pulmonary veins and posterior wall all failed to predict arrhythmia recurrence (all p > .10).
Conclusions: AF mechanisms as determined using ECGI mapping do not predict outcomes after PVI for persistent AF. Further studies using different methodologies to characterize AF mechanisms are warranted (NCT03394404).
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| http://dx.doi.org/10.1111/jce.15644 | DOI Listing |
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