Elongation of the high right atrium to coronary sinus conduction time predicts the recurrence of atrial fibrillation after radiofrequency catheter ablation

Abstract

Background: The impact of intra-atrial conduction delay on the recurrence of atrial tachyarrhythmia after radio frequency catheter ablation (RFCA) has not been fully elucidated. Methods: We retrospectively analyzed 155 AF patients who were sinus rhythm at the start of RFCA. The conduction time from the onset of the earliest atrial electrogram at the high right atrium (HRA) to the end of the latest electrogram at the coronary sinus (CS) during sinus rhythm was defined as HRA-CS conduction time. Pulmonary vein isolation (PVI) was performed followed by linear roof lesion and complex fractionated atrial electrogram (CFAE) ablation until AF termination. We evaluated atrial tachyarrhythmia recurrence 12 months after RFCA. Results: The follow-up data were available for 148 patients. The recurrence of atrial tachyarrhythmia was noted in 28 (18.9%) patients. Atrial tachyarrhythmia recurrence patients had longer HRA-CS conduction times (151.3 ± 22.1 ms vs 160.1 ± 32.6 ms, p = .017). The patients were divided into the long or short HRA-CS conduction time group. The Kaplan-Meier analysis revealed that the long HRA-CS conduction time group held a higher risk of atrial tachyarrhythmia recurrence (log-rank test, p = .019). The multivariable Cox hazard analysis revealed that a long HRA-CS conduction time was a significant risk factor for the recurrence of atrial tachyarrhythmia, despite a long AF duration, persistent AF, and larger left atrial diameter (LAD) were not statistically significant. Conclusions: The HRA-CS conduction time was the primary influencing factor that predicted the recurrence of atrial tachyarrhythmia after catheter ablation.

Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial

“…17 In another study performed in patients undergoing catheter ablation, right atrial conduction time was significantly associated with the occurrence of recurrent AF. 29 That study confirms our finding of increased conduction time as a robust, single point measurement, associated with the risk of recurrent AF. Moreover, we demonstrated that LAECT provides additional information on the arrhythmogenic substrate, beyond clinical characteristics and left atrial size, with prognostic implications for AF recurrence.…”

“…This seemingly contradictory finding may be the result of more preferential conduction along, compared with parallel to the fibres in more fibrotically remodelled atria, that is, of more anisotropy 17. In another study performed in patients undergoing catheter ablation, right atrial conduction time was significantly associated with the occurrence of recurrent AF 29. That study confirms our finding of increased conduction time as a robust, single point measurement, associated with the risk of recurrent AF.…”

Epicardial Connections as Intra-Atrial Conduction Routes in a Patient With Advanced Atrial Remodeling

“…Recent investigations have provided additional evidence to link IAC disturbance with AF. Kanemaru et al ( 11 ) measured conduction time between the high RA and the CS during SR as a surrogate of IAC time, and it was a predictor of AF recurrence after catheter ablation. Spies et al ( 10 ) focused on mechanisms of PQ interval prolongation in patients with atrial arrhythmias, and right IAC delay estimated by His bundle recording was a underlying cause in patients with AF and atrial flutter compared with the control group.…”

The Relevance of Heart Rate Fluctuation When Evaluating Atrial Substrate Electrical Features in Catheter Ablation of Paroxysmal Atrial Fibrillation

“…Despite the high interest in CS EGMs during AF, little or no attention has been paid to CS function during SR and its modification after CA procedures. Prolonged conduction time measured between EGMs from RA and CS in recordings acquired before CA of PVs and complex EGMs has shown high predictive power for atrial tachyarrhythmia occurrence [ 29 ]. Moreover, in CA of atrial flutter, fractionation in the EGMs of CS can predict the incidence of AF [ 30 ].…”