title: Characterising the difference in electrophysiological substrate and outcomes between heart failure and non-heart failure patients with persistent atrial fibrillation.
abstract: Characterizing the differences in substrate and clinical outcome between heart failure (HF) and non-heart failure (non-HF) patients undergoing persistent atrial fibrillation (AF) ablation.
  
  
  
  Using complex fractionated electrograms (CFE) as a surrogate marker of substrate complexity, we compared the bi-atrial substrate in patients with persistent AF with and without HF, at baseline and after ablation, to determine its impact on clinical outcome. In this retrospective analysis of two prospective studies, 60 patients underwent de-novo step-wise left atrial (LA) ablation, 30 with normal left ventricular ejection fraction (LVEF) ≥ 50% (non-HF group) and 30 with LVEF ≤ 35% (HF group). Multiple high-density bi-atrial CFE maps were acquired along with AF cycle length (AFCL) at each procedural stage. Change in bi-atrial CFE areas, AFCL and outcome data were then compared. In the non-HF group, higher CFE-areas were found at baseline and at each step of the procedure in the LA. In both LA and the right atrium (RA), baseline and final CFE area were also higher in the non-HF group. Single procedure, arrhythmia-free survival at 1 year was higher in the HF group compared with the non-HF group (72% vs. 43%, log rank P = 0.04). Final total bi-atrial CFE area was an independent predictor of arrhythmia recurrence.
  
  
  
  CFE represents an important surrogate marker of atrial substrate complexity. The atrial substrate in persistent AF differs between HF and non-HF with the latter representing a more complex 'primary' bi-atrial myopathy. LA focussed ablation results in more extensive substrate modification in HF and better clinical outcomes as compared with non-HF.
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Shouvik K
authors.initials: SK
authors.lastname: Haldar
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: David G
authors.initials: DG
authors.lastname: Jones
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Habib
authors.initials: H
authors.lastname: Khan
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Panikker
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Julian W E
authors.initials: JWE
authors.lastname: Jarman
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Charlie
authors.initials: C
authors.lastname: Butcher
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
authors.affiliation: Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Wynn
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.|Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Wajid
authors.initials: W
authors.lastname: Hussain
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Vias
authors.initials: V
authors.lastname: Markides
authors.affiliation: Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Institute of Cardiovascular Medicine and Science, Imperial College London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D000077982:Progression-Free Survival; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome