Antral pulmonary vein isolation achieved freedom from AF in 69% of paroxysmal and 49% of persistent AF patients, with a larger decrease in dominant frequency predicting success in persistent AF (P<0.05).
Cohort (n=77)
Do time- and frequency-domain characteristics of coronary sinus electrograms predict clinical outcomes after antral pulmonary vein isolation in patients with atrial fibrillation?
Complexity of coronary sinus electrograms may reflect drivers of AF that perpetuate paroxysmal AF after APVI, and changes in dominant frequency correlate with efficacy in persistent AF.
Absolute Event Rate: 69% vs 49%
BACKGROUND: The mechanistic and clinical significance of complex fractionated atrial electrograms (CFAE) in the coronary sinus (CS) has been unclear. METHODS AND RESULTS: Antral pulmonary vein isolation (APVI) was performed in 77 patients with paroxysmal (32) or persistent AF (45). CS electrograms recorded for 60 seconds before and after APVI were analyzed in the time- and frequency-domains. Dominant frequency (DF), complexity index (CI: change in polarity of depolarization), and fractionation index (FI: change in direction of depolarization slope) were determined. Before APVI, there was no difference in DF, CI, or FI between paroxysmal and persistent AF. APVI resulted in a significant decrease in DF, CI, and FI in all patients. Baseline CI (43 +/- 13/s vs 54 +/- 14/s, P = 0.03) and FI (64 +/- 23/s vs 87 +/- 30/s, P = 0.02) were lower in patients with paroxysmal AF who had AF terminated by ablation than who did not. At 10 +/- 2 months, 69% of patients with paroxysmal AF and 49% of patients with persistent AF were free from AF after single ablation. Baseline CI was higher among patients with paroxysmal AF who had AF after APVI (56 +/- 20/s vs 44 +/- 10/s, P = 0.03). In patients with persistent AF, there was a larger decrease in DF after APVI among patients who remained free from AF (13 +/- 11% vs 7 +/- 9%, P < 0.05). CONCLUSIONS: Complexity of CS electrograms may reflect drivers of AF that perpetuate paroxysmal AF after APVI. In persistent AF, the extent to which APVI decreases DF in the CS correlates with efficacy, suggesting that DF identifies patients who may require additional ablation beyond APVI.
Yoshida et al. (Mon,) conducted a cohort in Paroxysmal and persistent atrial fibrillation (n=77). Antral pulmonary vein isolation (APVI) vs. Persistent vs paroxysmal AF / Baseline was evaluated on Freedom from AF after single ablation. Antral pulmonary vein isolation achieved freedom from AF in 69% of paroxysmal and 49% of persistent AF patients, with a larger decrease in dominant frequency predicting success in persistent AF (P<0.05).
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