SPC365

Invasive atrial conduction interval as a marker of atrial disease and an instrument of predicting atrial fibrillation recurrence after successful catheter ablation

Session: Posters (Sessão 1 - Écran 1) - Ablação Fibrilhação Auricular
Speaker: João Grade Santos

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.4 Atrial Fibrillation - Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: João Grade Santos; Mariana Martinho; Bárbara Ferreira; Diogo Cunha; João da Luz; Nazar Ilchyshyn; Oliveira Baltasar; Daniel Sebaiti; Khrystyna Budzak; João Simões; Rita Miranda; Sofia Almeida; Luís Brandão; Hélder Pereira

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Introduction:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;Catheter ablation for the treatment of Atrial Fibrillation (AF) is a modality of treatment in growing expansion. However, the sustained long-term response in preventing AF recurrence is poor for many patients and an adequate patient selection and tailored follow-up is paramount.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Purpose:</span></span></strong><span style="background-color:white"><span style="color:#222222">&nbsp;Our aim was to assess the utility of invasive electrophysiological parameters of intra and inter atrial conduction, namely the interval between the earliest recorded atrial activity (the onset of the P-wave) and the atrial electrogram (PA) in the distal coronary sinus (CS) bipole, measured in the electrophysiological study prior to the catheter ablation, in predicting AF recurrences after a</span></span><span style="color:black"> successful ablation.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Methods</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;We performed a 2-year retrospective analysis, between November 2020 and April 2022, of all patients who underwent a successful catheter ablation for the treatment of atrial fibrillation and whose electrophysiological tracings were available in a single expert centre.&nbsp;Medical records were analysed for demographic, procedural data and outcomes.</span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#222222">Results</span></span></strong><span style="background-color:white"><span style="color:#222222">:&nbsp;Forty-five (45) patients fulfilled all inclusion criteria and were analysed. The mean age was 62 </span></span><span style="color:black">&plusmn; 9,1 with a male preponderance (55,6%). The majority of patients (62%) had paroxistical AF, followed by long term persistent AF (27%) and persistent AF (11%). The average PA interval was 87 &plusmn; 14ms. There was a trend towards linear correlation between the PA interval and left atrium indexed volume although it did not reach statistical significancy (p = 0,07) (Figure 1). An AF recurrence occurred in 8 (17,8%) of patients at follow-up. A greater PA interval was a predictor of recurrence in the total follow up (OR 1,13; 95% CI 1,01&ndash;1,264, <em>p</em>= 0,03) and showed a good discriminative capacity with the ROC curve analysis (figure 2) demonstrating an AUC of 0,84. There was a trend for prediction of recurrence at 6 months and 1 year (OR 1,04; 95% CI 0,98&ndash;1,10, <em>p</em>= 0,08 and OR 1,06; 95% CI 0,99&ndash;1,15, <em>p</em>= 0,07 respectively) although it did not reach statistical significancy.</span></span></span></span></p>

<p><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">Conclusions</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">:&nbsp;This represents a proof-of-concept of, to our knowledge, one of the first studies on an </span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">invasive atrial conduction measurement as a predictor of Atrial Fibrillation recurrence after catheter ablation. Greater intra and inter atrial conduction delay (characterized by the PA interval measured in the distal CS) trends towards correlation with structural left atrium pathology </span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#222222">and was associated with an increased recurrence rate at a short follow up. A greater sample size and subsequent sub-group analysis is required to assess its magnitude of effect and potential clinical application.</span></span></span></span></p>