Advertisement

CA-529-01 RENEWAL THEORY: A STATISTICAL APPROACH TO IMPROVE PATIENT SELECTION FOR PULMONARY VEIN ISOLATION-ONLY STRATEGY IN ATRIAL FIBRILLATION ABLATION

      Background

      Outcomes from pulmonary vein isolation (PVI)-only approach in AF remain suboptimal, especially in persistent AF (persAF) patients. However,results from STAR-AF 2 trial suggest the presence of a subgroup of persAF patients who were responders to PVI-only. While research efforts have primarily focused on which non-PVI ablation techniques to pursue in persAF patients, there has been a paucity of data to define a cohort of AF patients who are “PVI-only responders”

      Objective

      We recently showed a physiological assessment of fibrillatory dynamics could be performed using renewal theory, which determines rates of phase singularity formation (λ f ) and destruction (λ d ). Using the renewal approach, we aimed to define a cohort of patients who would be responsive to PVI-only approach, independent of the persAF status.

      Methods

      RENEWAL-AF is a prospective multicentre observational study recruiting AF ablation patients. Unipolar electrograms were obtained from sixteen biatrial locations using a 16-electrode Advisor TM HD-Grid catheter. Renewal rate constants λf , λd and the rho (ρ) values (λf / λd) were calculated. All patients had radiofrequency ablation using a PVI-only approach.

      Results

      N=48 AF patients were recruited (mean age 59.1 ± 9.4 years, 28.5% females). Two groups were analyzed; Phenogroup 1 (Ph1), highest ρ in pulmonary veins, Phenogroup 2 (Ph2), highest ρ in LA body. Ph1 patients had a lower CHA2 DS2 -VASc score (P=0.02), and a smaller LA volume index (P=0.04) compared to Ph2. After a follow-up of 5.15 ± 1.6 months, Ph1 was associated with lower atrial tachyarrhythmia (AT) recurrences (P=0.047) with a lower AF burden (P=0.026). No association was found between persAF status with AF Phenogroup classification (P=0.68), AF burden (P=0.58), or AF recurrence (P=0.52). Additionally, AF Phenogroup was a significant predictor of AF recurrence in both univariate (β +0.32, 95% CI 0.002 0.64, P=0.048) and multivariate analysis (β+0.34, 95% CI 0.039 0.65, P=0.028).