TY - JOUR
T1 - Persistent Atrial Fibrillation from the Onset
T2 - A Specific Subgroup of Patients with Biatrial Substrate Involvement and Poorer Clinical Outcome
AU - Lim, Han S.
AU - Denis, Arnaud
AU - Middeldorp, Melissa E.
AU - Lau, Dennis H.
AU - Mahajan, Rajiv
AU - Derval, Nicolas
AU - Albenque, Jean Paul
AU - Boveda, Serge
AU - Zellerhoff, Stephan
AU - Yamashita, Seigo
AU - Berte, Benjamin
AU - Mahida, Saagar
AU - Komatsu, Yuki
AU - Daly, Matthew
AU - Jesel, Laurence
AU - Pomier, Carole
AU - Meillet, Valentin
AU - Dubois, Remi
AU - Amraoui, Sana
AU - Shah, Ashok
AU - Sacher, Frédéric
AU - Cochet, Hubert
AU - Hocini, Mélèze
AU - Jaïs, Pierre
AU - Sanders, Prashanthan
AU - Haïssaguerre, Michel
N1 - Publisher Copyright:
© 2016 American College of Cardiology Foundation.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Objectives This study sought to characterize the clinical characteristics, atrial substrate, and prognosis in a subgroup of patients with persistent atrial fibrillation (AF) from the onset (PsAFonset). Background Patients with AF frequently progress from trigger-driven paroxysmal arrhythmias to substrate-dependent persistent arrhythmias. Methods Patients referred for persistent AF (PsAF) ablation were enrolled from 3 centers. Consecutive patients with PsAFonset (n = 129) were compared with patients with PsAF that progressed from paroxysmal AF (n = 231). In addition, 90 patients (30 patients with PsAFonset and 60 control subjects) were studied with noninvasive mapping to characterize the AF drivers. The degree of fractionation and endocardial voltages were assessed invasively. Results Patients with PsAFonset were younger (p = 0.047) and more obese (p < 0.001); there were more men (p = 0.034), more patients with hypertension (p = 0.044), and these patients had larger left (p < 0.05) and right atria (p < 0.05). Baseline AF cycle length was shorter in the PsAFonset group (p < 0.01); the degree of fractionation was higher (p < 0.001 for both atria), and the endocardial voltage was lower (p < 0.05 for both atria). Patients with PsAFonset had higher a number of re-entrant driver regions (p < 0.001) and extrapulmonary vein regions that had re-entrant drivers (p < 0.05), whereas control subjects displayed more focal driver regions (p = 0.029). The acute AF termination rate was lower in the PsAFonset group (42% vs. 81%; p < 0.001). During a mean follow-up of 17 ± 11 months from the last procedure, patients with PsAFonset had significantly higher AF, atrial tachycardia (AT), and AF/AT recurrence rates (p < 0.01). Conclusions Patients with PsAFonset represent a distinct subgroup defined by specific demographics, underlying diffuse biatrial substrate disease, and worse clinical outcome. The findings highlight the importance of defining criteria for early detection of atrial substrate disease.
AB - Objectives This study sought to characterize the clinical characteristics, atrial substrate, and prognosis in a subgroup of patients with persistent atrial fibrillation (AF) from the onset (PsAFonset). Background Patients with AF frequently progress from trigger-driven paroxysmal arrhythmias to substrate-dependent persistent arrhythmias. Methods Patients referred for persistent AF (PsAF) ablation were enrolled from 3 centers. Consecutive patients with PsAFonset (n = 129) were compared with patients with PsAF that progressed from paroxysmal AF (n = 231). In addition, 90 patients (30 patients with PsAFonset and 60 control subjects) were studied with noninvasive mapping to characterize the AF drivers. The degree of fractionation and endocardial voltages were assessed invasively. Results Patients with PsAFonset were younger (p = 0.047) and more obese (p < 0.001); there were more men (p = 0.034), more patients with hypertension (p = 0.044), and these patients had larger left (p < 0.05) and right atria (p < 0.05). Baseline AF cycle length was shorter in the PsAFonset group (p < 0.01); the degree of fractionation was higher (p < 0.001 for both atria), and the endocardial voltage was lower (p < 0.05 for both atria). Patients with PsAFonset had higher a number of re-entrant driver regions (p < 0.001) and extrapulmonary vein regions that had re-entrant drivers (p < 0.05), whereas control subjects displayed more focal driver regions (p = 0.029). The acute AF termination rate was lower in the PsAFonset group (42% vs. 81%; p < 0.001). During a mean follow-up of 17 ± 11 months from the last procedure, patients with PsAFonset had significantly higher AF, atrial tachycardia (AT), and AF/AT recurrence rates (p < 0.01). Conclusions Patients with PsAFonset represent a distinct subgroup defined by specific demographics, underlying diffuse biatrial substrate disease, and worse clinical outcome. The findings highlight the importance of defining criteria for early detection of atrial substrate disease.
KW - catheter ablation
KW - persistent atrial fibrillation
KW - presentation
KW - prognosis
KW - substrate
UR - https://www.scopus.com/pages/publications/84963796129
U2 - 10.1016/j.jacep.2015.12.014
DO - 10.1016/j.jacep.2015.12.014
M3 - Article
AN - SCOPUS:84963796129
SN - 2405-500X
VL - 2
SP - 129
EP - 139
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 2
ER -