Key result
Longer left atrial epicardial conduction time is linked to higher AF recurrence after thoracoscopic ablation.
Why the study?
To determine whether left atrial epicardial conduction time reflects atrial fibrosis and AF recurrence after thoracoscopic surgical ablation of persistent AF.
Does left atrial epicardial conduction time reflect atrial fibrosis and predict the risk of atrial fibrillation recurrence after thoracoscopic ablation in patients with persistent AF?
RCT (n=121)
No
Does left atrial epicardial conduction time reflect atrial fibrosis and predict the risk of atrial fibrillation recurrence after thoracoscopic ablation in patients with persistent AF?
Left atrial epicardial conduction time is independently associated with atrial fibrillation recurrence after thoracoscopic ablation, reflecting underlying substrate characteristics.
LAECT may refine recurrence risk stratification after thoracoscopic ablation; hypothesis-generating and requires prospective validation.
OBJECTIVES: To determine the association between left atrial epicardial conduction time (LAECT), fibrosis and atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation of persistent AF. SETTING: Single tertiary care centre in the Netherlands. PARTICIPANTS: Patients with persistent AF from the randomised Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery (AFACT)-trial were included. Patients eligible for thoracoscopic AF ablation were included, full inclusion and exclusion criteria were previously published. All patients underwent thoracoscopic ablation, encompassing pulmonary vein isolation with an additional roof and trigone lesion. In patients with conduction block across the roof and trigone lesion, LAECT was measured. LAECT was defined as the time to local activation at one side of the roofline on pacing from the opposite side. Collagen fibre density was quantified from left atrial appendage histology. OUTCOME MEASURES: Primary outcome: AF recurrence during 2 years of follow-up. RESULTS: 121 patients were included, of whom 35(29%) were women, age was 60.4±7.8 and 51% (62) had at least one AF recurrence during 2 years of follow-up. LAECT was longer in patients with versus without AF recurrence (182±43 ms vs 147±29 ms, p<0.001). LAECT was longer in older patients, in patients with a higher body mass index (BMI) and in patients using class IC antiarrhythmic drugs. LAECT was shorter in patients with higher collagen fibre density. A previously failed catheter ablation, LAECT and BMI were independently associated with AF recurrence. CONCLUSION: LAECT is correlated with collagen fibre density and BMI and is independently associated with AF recurrence in patients with persistent AF. In these patients, LAECT appears to reflect substrate characteristics beyond clinical AF type and left atrial volume. TRIAL REGISTRATION NUMBER: NCT01091389.
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Wesselink et al. (2022) conducted an RCT in persistent atrial fibrillation (n=121). Left atrial epicardial conduction time (LAECT) assessment was evaluated on AF recurrence during 2 years of follow-up (p=<0.001). Longer left atrial epicardial conduction time was independently associated with atrial fibrillation recurrence over 2 years following thoracoscopic ablation (182±43 ms vs 147±29 ms; p<0.001).
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