Dhillon, GS;
Honarbakhsh, S;
Graham, A;
Abbass, H;
Welch, S;
Daw, H;
Sporton, S;
... Hunter, RJ; + view all
(2022)
ECG-I Phenotyping of Persistent AF Based on Driver Burden and Distribution to Predict Response to Pulmonary Vein Isolation (PHENOTYPE-AF).
Journal of Cardiovascular Electrophysiology
, 33
(11)
pp. 2263-2273.
10.1111/jce.15644.
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Abstract
BACKGROUND: This prospective trial sought to phenotype persistent AF based on AF mechanisms using ECGI mapping to determine whether this would predict long term freedom from arrhythmia after pulmonary vein isolation (PVI). METHODS: Patients with persistent AF of < 2 years duration underwent cryoballoon PVI. ECGI mapping was performed prior to PVI to determine potential drivers (PDs) defined as rotational activations completing ≥ 1.5 revolutions or focal activations. The co-primary end point was the association between (1) PD burden (defined as the number of PD occurrences) and (2) PD distribution (defined as the number of segments on an 18 segment model of the atria harbouring PDs) with freedom from arrhythmia at 1 year follow up. RESULTS: Of 100 patients, 97 completed follow up and 52 (53.6%) remained in sinus rhythm off antiarrhythmic drugs. Neither PD burden nor PD distribution predicted freedom from arrhythmia (HR 1.01, 95% CI 0.99 - 1.03, p = 0.164; and HR 1.04, 95% CI 0.91 - 1.17, p = 0.591 respectively). Otherwise, the burden of rotational PDs, rotational stability, and the burden of PDs occurring at the pulmonary veins and posterior wall all failed to predict arrhythmia recurrence (all p > 0.10). CONCLUSIONS: AF mechanisms as determined using ECGI mapping do not predict outcome after PVI for persistent AF. Further studies using different methodologies to characterise AF mechanisms are warranted. (NCT03394404) This article is protected by copyright. All rights reserved.
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