Electrocardiographic characteristics of 5-year atrial tachy-arrhythmia free patients after catheter ablation for atrial fibrillation

Abstract

Background Predictors are not well known for long-lasting sinus rhythm after atrial fibrillation catheter ablation (AFCA). Purpose We investigated the pre-procedural clinical factors associated with the patients with 5-year long-term atrial fibrillation (AF) free after AFCA. Methods Among 2,085 patients who underwent de novo AFCA, 934 patients (58±11 years, 73.1% male, 66.0% paroxysmal AF), who underwent guidelines-based rhythm follow-up longer than 5-years, were included in this study. We compared 340 patients who never showed AF recurrence for 5-years and 594 patients with AF/ atrial tachycardia (AT) recurrence at least a single episode. Cut-off values of pericardial fat volume and electrocardiogram (ECG) parameters were obtained by Youden index. Results 1. The patients with AF-free for 5-years (AF-Free-5yrs) had higher proportion of paroxysmal AF (p<0.001), lower body mass index (p=0.020), and lower proportion of pre-existing congestive heart failure (p=0.035), and smaller LA size (p<0.001) than those who experienced recurrence. 2. The patients with AF-Free-5yrs showed lower pericardial fat volume (105.9±47.5 vs. 121.2±53.cm3, p<0.001) and shorter PR interval (181.5±29.6 vs. 190.5±33.1ms, p<0.001) and P wave duration in lead II (PWDII, 121.1±18.0 vs. 129.4±18.8ms, p<0.001) rather than those of counter-part. 3. Multivariate regression analysis revealed that paroxysmal AF at the procedure, lower pericardial fat volume (OR 0.995, 95% CI [0.991–0.998], p=0.004), short PR interval (OR 0.994, 95% CI [0.988–1.000], p=0.038), and PWDII (OR 0.986, 95% CI [0.978–0.995], p=0.002) were independently associated with the AF-Free-5yrs. 3. Among the patients with persistent AF, PWDII was significantly shorter in AF-Free-5yrs group. (123.7±22.6 vs. 133.5±19.5, p<0.001), and PWDII <127.1ms was independently associated with AF-Free-5yrs (OR 3.114, 95% CI [1.819–5.331], p<0.001). Conclusions Pericardial fat volume (<113.7cm3) and PR interval (<196 ms) in pre-procedural ECG was independently associated with an excellent 5-year rhythm outcome after AFCA, and PWDII (<127.1 ms) predicted super-responders especially after persistent AF ablation. Funding Acknowledgement Type of funding source: None