Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Mapping & Imaging D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-166 - Right Atrial Appendage Drivers During Atrial Fibrillation Ablation: Prevalence And Characteristics In 571 Consecutive Atrial Fibrillation Ablation Procedures (ID 1217)


Background: The role of AF drivers located at the left atrium, superior vena cava, crista terminalis and coronary sinus (CS) is well established. While these regions are classically targeted during catheter ablation, the role of right atrial appendage (RAA) drivers has been incompletely investigated.
Objective: To determine the prevalence and electrophysiological characteristics of AF drivers arising from the RAA.
Methods: We conducted a retrospective analysis of clinical and procedural data of 571 consecutive patients (2015-2019) who underwent an AF ablation procedure after biatrial mapping (multipolar catheter, > 2000 points). We selected patients who presented with a per-procedural RAA firing (RAAF). RAAF was defined as the recording of a sustained RAA EGM characterized by a cycle length shorter than the one of electrograms recorded at the CS.
Results: Of 571 patients, AF terminated in the right atrium in 49 patients. 21 patients (3.6%) presented with a RAAF. These patients were mostly men (76%), mean age: 62 yo (49;75) without structural heart disease (76%). RAAFs were predominantly found in paroxysmal AF patients (62%, 13% and 5% for paroxysmal, short standing and long-standing AF, respectively). As shown in the Figure, RAAF mean cycle length was 102 ms (78; 126) while CS cycle length was 191 ms (162; 220) p<0.05. When the ablation of RAAFs was feasible (74% of the patients) AF termination ensued.
Conclusion: In a consecutive series of 571 AF ablation procedures, we found that RAA drivers predominantly occur in patients with paroxysmal AF. These observations suggest that when PVI fails, a bi-atrial mapping may uncover the presence of RAAFs.