Antonio Frontera, Francesco Villella, Ernesto Cristiano, Francesca Comi, Alessia Latini, Carlo Ceriotti, Paola Galimberti, Donah Zachariah, Gabriele Pinna, Antonio Taormina, Kostantinos Vlachos, Mikaël Laredo, Pablo J Sánchez-Millán, Diego Penela Maceda, Andrea Bernardini, Fabrizio Bologna, Andrea Giomi, Giuseppe Augello, Gianluca Botto, Stylanios Tzeis, Patrizio Mazzone
{"title":"The functional substrate in patients with atrial fibrillation is predictive of recurrences following catheter ablation.","authors":"Antonio Frontera, Francesco Villella, Ernesto Cristiano, Francesca Comi, Alessia Latini, Carlo Ceriotti, Paola Galimberti, Donah Zachariah, Gabriele Pinna, Antonio Taormina, Kostantinos Vlachos, Mikaël Laredo, Pablo J Sánchez-Millán, Diego Penela Maceda, Andrea Bernardini, Fabrizio Bologna, Andrea Giomi, Giuseppe Augello, Gianluca Botto, Stylanios Tzeis, Patrizio Mazzone","doi":"10.1016/j.hrthm.2024.09.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Enhanced characterization of the atrial electrical substrate may lead to better comprehension of atrial fibrillation (AF) pathophysiology.</p><p><strong>Objective: </strong>With the use of high-density substrate mapping, we sought to investigate the occurrence of functional electrophysiological phenomena in the left atrium and to assess potential association with arrhythmia recurrences following catheter ablation.</p><p><strong>Methods: </strong>Sixty-three consecutive patients with AF referred for ablation were enrolled. Conduction abnormalities analysis relied on two acquired left atrial electro-anatomical maps (sinus and atrial paced rhythm). We classified conduction abnormalities as fixed (if these were present in both rhythms), or functional rhythm-dependent (if unmasked in one of the two rhythms). Esophagus and aorta locations were recorded to check the correspondence with abnormal conduction sites.</p><p><strong>Results: </strong>234 conduction abnormalities were detected, of which 125 (53.4%) were functional rhythm-dependent. In sinus rhythm the most frequent anatomical site of functional phenomena was the anterior wall followed by the posterior wall and in paced rhythm, the pulmonary venous antra. Sites of functional phenomena in 82.6% of cases corresponded with extra-cardiac structures such as sinus of Valsalva of ascending aorta anteriorly and the esophagus posteriorly. The vast majority (88%) of areas with functional phenomena had normal bipolar voltage. After pulmonary vein ablation, the number of residual functional phenomena is an indipendent predictor of AF recurrence (HR 2.539 [1.458 - 4.420], p-value = 0.001) with a risk of recurrences at multivariable Cox analysis.</p><p><strong>Conclusions: </strong>Dual high-density mapping (during sinus and paced rhythms) is able to unmask functional, rhythm-dependent, phenomena which are predictive of AF recurrences during the follow-up.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":null,"pages":null},"PeriodicalIF":5.6000,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2024.09.017","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Enhanced characterization of the atrial electrical substrate may lead to better comprehension of atrial fibrillation (AF) pathophysiology.
Objective: With the use of high-density substrate mapping, we sought to investigate the occurrence of functional electrophysiological phenomena in the left atrium and to assess potential association with arrhythmia recurrences following catheter ablation.
Methods: Sixty-three consecutive patients with AF referred for ablation were enrolled. Conduction abnormalities analysis relied on two acquired left atrial electro-anatomical maps (sinus and atrial paced rhythm). We classified conduction abnormalities as fixed (if these were present in both rhythms), or functional rhythm-dependent (if unmasked in one of the two rhythms). Esophagus and aorta locations were recorded to check the correspondence with abnormal conduction sites.
Results: 234 conduction abnormalities were detected, of which 125 (53.4%) were functional rhythm-dependent. In sinus rhythm the most frequent anatomical site of functional phenomena was the anterior wall followed by the posterior wall and in paced rhythm, the pulmonary venous antra. Sites of functional phenomena in 82.6% of cases corresponded with extra-cardiac structures such as sinus of Valsalva of ascending aorta anteriorly and the esophagus posteriorly. The vast majority (88%) of areas with functional phenomena had normal bipolar voltage. After pulmonary vein ablation, the number of residual functional phenomena is an indipendent predictor of AF recurrence (HR 2.539 [1.458 - 4.420], p-value = 0.001) with a risk of recurrences at multivariable Cox analysis.
Conclusions: Dual high-density mapping (during sinus and paced rhythms) is able to unmask functional, rhythm-dependent, phenomena which are predictive of AF recurrences during the follow-up.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.