Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO03 - Poster Session III (ID 48) Poster

D-PO03-189 - Natural History Of Arrhythmia In Patients With Paroxysmal Atrial Fibrillation After Successful Pulmonary Vein Isolation Procedure (ID 1148)

  A. Natale: Honoraria/Speaking/Consulting Fee - Medtronic; Biosense Webster, Inc.; Boston Scientific; Abbott; Baylis Medical Company; Biotronik.


Background: Pulmonary vein isolation (PVI) is the cornerstone of ablation therapy in paroxysmal AF (PAF).
Objective: We evaluated the natural course of AF after effective PVI in PAF patients with vs. without comorbidities.
Methods: Consecutive PAF patients receiving PVI+ isolation of left atrial posterior wall and superior vena cava at our center were monitored and those remaining arrhythmia-free for at least 2 years after the procedure were included in the analysis. Based on their comorbidity status, patients were divided into, group 1: no comorbidities with exception of well-controlled hypertension using single drug and group 2: > 1 of the comorbid conditions [moderate-severe OSA, hypertension, diabetes, obesity, dyslipidemia and left ventricular ejection fraction <45%].
Results: A total of 692 and 941 patients were included in group 1 and 2 respectively. At 10 years of follow-up, 215 (31%) from group 1 and 480 (51%) from group 2 had recurrence (p<0.001). Of note, in group 2, recurrence rate in patients with obesity +OSA (n=368) was significantly higher compared to the rest of the group (205 (55.7%) vs 275 (48%); HR 1.33 (1.11-1.59), p=0.002). Median time to recurrence was 7.4 (IQR 4.3-8.5) years in group 1 and 6.8 (IQR 3.8-8.3) years in group 2 (p=0.01). A total of 147 patients from group 1 and 414 from group 2 underwent repeat ablation at our center. At the redo, no PV reconnection was detected in the study population. Triggers from left atrial appendage (LAA) and coronary sinus (CS) were detected in 106 (72%) from group 1 and 378 (91.4%) from group 2 (p<0.001). Electrical isolation of the LAA and CS was performed in these patients. In the remaining patients from both groups, LAA and CS were empirically isolated. At 2 years follow-up, 134/147 (91%) and 391/414 (94.4%) remained arrhythmia-free off-drugs (p=0.16).
Conclusion: In PAF patients with successful PVI, median time to recurrence was significantly shorter in patients with comorbidities. Additionally, recurrence rate was significantly higher in those with obesity plus OSA compared to the rest of the group 2 population. Furthermore, regardless of the comorbidity status, late recurrence was majorly driven by triggers from LAA and CS and superior success rate was achieved after electrical isolation of both structures.