PREDICTORS OF DEATH AND STROKE IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION: Results FROM THE CANADIAN REGISTRY OF ATRIAL FIBRILLATION

BACKGROUND: Catheter ablation is a highly effective therapy for the long-term management of paroxysmal atrial fibrillation (AF), but the results in persistent AF are more limited. Predictors of success after ablation in this group of patients, especially if long-standing, are not well defined. AIM: The purpose of this study was to determine the association between complex atrial fractionated electrograms (CFAE) surface area or low-voltage area with long-term outcomes after catheter ablation for long-standing persistent AF. METHODS: We included 68 patients with persistent AF 12 months undergoing de novo catheter ablation using a stepwise approach. Bipolar electrogram fractionation and voltage were registered during AF. Regions with a mean cycle length (mCL) between 50-120 ms were considered CFAE and a peak-to-peak bipolar voltage less than 0.1 mV was defined as abnormal. RESULTS: The mean age of the patients was 64 9 years, with 76% being male, duration of AF 86 94 months, LA volume 132 36 ml. Conversion to sinus rhythm or organization into atrial tachycardia with ablation was achieved in 69% of patients during ablation. CFAE involved 48 17% of the LA area and low-voltage was recorded from 11 11%. After a follow-up of 23 14 months 51% of patients were free of arrhythmia recurrences. In patients that recurred the area of low-voltage was greater than in those who remained free of arrhythmias (8 vs 15%, p 0.03). No differences were observed regarding the CFAE surface area. CONCLUSION: In conclusion, among patients with longstanding persistent AF a larger low-voltage area is associated with increased recurrence of arrhythmia during follow-up.