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Decoding the Complexity of Atrial Fibrillation: Unveiling Distinct Phenotypes of Voltage and Conduction Velocity
Session:
Sessão de Posters 31 - Fibrilhação auricular: dos mecanismos ao tratamento
Speaker:
Pedro Silva Cunha
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Pedro Silva Cunha
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">Low atrial voltage and slow conduction velocity have been associated with atrial fibrillation (AF), but their interaction and relative importance as early disease markers<u><span style="color:teal"> </span></u>remain incompletely understood. Here, we aimed to elucidate the relationship between atrial voltage and conduction velocity in high-density electroanatomic maps from patients with AF. </span></span></span></span><strong><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">Methods:</span></span></span></strong> <span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">High-density electroanatomic maps obtained during sinus rhythm from 52 patients with AF and five healthy controls were retrospectively analysed. The data acquired during AF ablation using the CARTO3 v7 system and a high-density catheter was analysed. Atrial voltage and conduction velocity maps were generated, and their correlations were statistically assessed globally. Subgroup analyses were performed based on clinically relevant factors, such as AF type, conduction velocity, and voltage levels. A cluster analysis was conducted to identify distinct phenotypes within the population, reflecting different patterns of conduction and voltage. </span></span></span></span></span></span></span></p> <p><strong><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">Results: </span></span></span></span></strong><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">There was a moderate positive correlation between atrial voltage and conduction velocity (r=0.570). Three distinct phenotypes emerged: normal voltage/normal conduction velocity, normal voltage/low conduction velocity, and low voltage/low conduction velocity, suggesting different disease progression paths. Some patients with normal atrial voltage exhibited low conduction velocities. Analysis between subgroups revealed significant differences in voltage (p=0.0044) but not in conduction velocity (p=0.42), with no significant differences between paroxysmal and persistent AF types. Lower atrial conduction velocity was identified as a significant predictor of arrhythmia recurrence at 12 and 24 months after AF ablation, surpassing the predictive potential of atrial voltage. </span></span></span></span><strong><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">Conclusion: </span></span></span></span></strong><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="color:#505050">Atrial voltage and conduction velocity analysis uncovered distinct phenotypes with unique patterns of conduction and voltage. Lower atrial conduction velocity emerged as a significant predictor of AF recurrence, surpassing the predictive potential of atrial voltage. These findings emphasise the importance of considering conduction velocity and voltage in managing AF, offering potential insights for personalised strategies.</span></span></span></span></p>
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