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Impact of pulmonary vein isolation on mechanisms sustaining persistent atrial fibrillation: predicting the acute response

Dhillon, GS; Schilling, RJ; Honarbakhsh, S; Graham, A; Abbass, H; Waddingham, P; Sawhney, V; ... Hunter, RJ; + view all (2020) Impact of pulmonary vein isolation on mechanisms sustaining persistent atrial fibrillation: predicting the acute response. Journal of Cardiovascular Electrophysiology , 31 (4) pp. 903-912. 10.1111/jce.14392. Green open access

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Abstract

BACKGROUND: Non-invasive mapping identifies potential drivers (PDs) in AF. We analysed the impact of pulmonary vein isolation (PVI) on PDs and whether baseline PD pattern predicted termination of AF. METHODS: Patients with persistent AF < 2 years underwent ECGI mapping before and after cryoballoon PVI. We recorded the number of PD occurrences, characteristics (rotational wavefronts ≥ 1.5 revolutions or focal activations) and distribution using an 18-segment atrial model. RESULTS: Of 100 patients recruited, PVI terminated AF in 15 patients. 21.3 ± 9.1% (8.7 ± 4.8) of PDs occurred at the PVs and posterior wall. PVI had no impact on PD occurrences outside the PVs and posterior wall (33.2 ± 12.9 vs 31.6 ± 12.5, p = 0.164), distribution over the remaining 13 segments (9 (8 - 11) vs 9 (8 -10), p = 0.634), the proportion of PDs that were rotational (82.9 ± 9.7% vs 83.6 ± 10.1%, p = 0.496) or temporal stability (2.4 ± 0.4 vs 2.4 ± 0.5 rotations, p = 0.541). Fewer focal PDs (AUC 0.683,95% CI 0.528 - 0.839, p = 0.024) but not rotational PDs (p = 0.626) predicted AF termination with PVI. CONCLUSIONS: PVI did not have a global impact on PDs outside the PVs and posterior wall. Although fewer focal PDs predicted termination of AF with PVI, the burden of rotational PDs did not. It is accepted though not all PDs are necessarily real or important. Outcome data is needed to confirm whether non-invasive mapping can predict patients likely to respond to PVI. This article is protected by copyright. All rights reserved.

Type: Article
Title: Impact of pulmonary vein isolation on mechanisms sustaining persistent atrial fibrillation: predicting the acute response
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/jce.14392
Publisher version: https://doi.org/10.1111/jce.14392
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Drivers, Mechanisms of Atrial Fibrillation, Non-invasive Mapping, Persistent Atrial Fibrillation, Pulmonary Vein Isolation
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10092335
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