Atrial fibrillation cycle length is a sole independent predictor of a substrate for consecutive arrhythmias in patients with persistent atrial fibrillation.
BACKGROUND
Termination of persistent atrial fibrillation (AF) can be achieved through ablation, with the majority of patients terminating to an atrial tachycardia (AT) and fewer directly to sinus rhythm (SR). We aimed to identify potential predictors for the existence of a substrate for AT on termination to SR.


RESULTS
We assessed 95 persistent AF patients (age, 60+/-10 years) who underwent catheter ablation to the end point of AF termination. Forty patients terminated directly to SR (SRterm) and 55 to ATs (ATterm). Compared with the ATterm group, the SRterm group were younger (56+/-10 versus 63+/-9 years, P=0.001), had shorter durations of AF before ablation (9+/-26 versus 14+/-20 months, P<0.001), smaller left atrial diameters (41+/-5 versus 45+/-5 mm, P=0.015), and longer baseline AF cycle lengths (178+/-23 versus 159+/-31 ms, P=0.005). However, AF cycle length was the sole independent predictor of direct termination to SR. The most frequent AF termination site in SRterm patients was the pulmonary veins (53%), whereas in ATterm patients this was within the left atrium (58%). After follow-up of 12+/-6 months, there was a trend toward a greater proportion of patients in SR among those who terminated directly to SR after a single procedure. The most frequent type of recurrence was paroxysmal AF in SRterm patients and AT in ATterm patients.


CONCLUSIONS
Patients who terminate to SR through ablation without an intermediate AT are characterized by a less altered arrhythmogenic substrate. Baseline AF cycle lengths emerged as a sole independent predictor of a substrate for consecutive arrhythmias.
Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Martinistrasse 52, Hamburg, Germany. idrewitz@uke.uni-hamburg.de
Imke
I
Drewitz
Stephan
S
Willems
Tushar V
TV
Salukhe
Daniel
D
Steven
Boris A
BA
Hoffmann
Helge
H
Servatius
Karsten
K
Bock
Muhammet Ali
MA
Aydin
Karl
K
Wegscheider
Thomas
T
Meinertz
Thomas
T
Rostock
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D016009:Chi-Square Distribution; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome