Abstract 12943: Long-Term Ablation Outcome in Patients With Coexistent Metabolic Syndrome and Long-Standing Persistent Atrial Fibrillation Undergoing First Catheter Ablation: Results From a Propensity-Matched Population

Abstract

Introduction: Procedure-outcome after catheter ablation in long-standing persistent atrial fibrillation (LSPAF) is reported to be highly variable with different ablation approaches. Metabolic syndrome (MS), a pro-inflammatory state, is also considered to be closely associated with recurrent AF. Purpose: We evaluated the long-term outcome with different ablation strategies in patients with coexistent MS and LSPAF Methods: Consecutive patients with LSPAF and MS undergoing their first catheter ablation were classified into two groups; group 1: standard ablation: PVAI extended to the entire posterior wall (PW) plus empirical isolation of superior vena cava (SVC) and group 2: standard ablation+ ablation of non-PV (NPV) triggers. Ablation strategy was based on operators’ discretion. In order to attenuate the between-group imbalance of the baseline covariates, a propensity score-matching technique was used resulting in 108 and 432 (1: 4) patients in gr 1 and 2 respectively. Arrhythmia-monitoring was performed quarterly for 1 year and biannually afterwards. Ablation success was assessed off-antiarrhythmic drugs (AAD). Results: All patients received PVAI plus isolation of left atrial PW and SVC (standard ablation). Following the standard ablation, high-dose isoproterenol challenge (25-30 μg/min for 10-15 min) was performed in group 2 (n=432) patients to identify non-PV triggers. These were detected in LAA (294, 68%), CS (315, 73%), inter-atrial septum (125, 29%) and crista terminalis (76, 17.6%). These sites were ablated using additional radiofrequency energy. Isoproterenol challenge to reveal non-PV triggers was not performed in group 1 (n=108) patients. Procedural complications included 3 (2.7%) and 6 (1.4%) groin hematomas in group 1 and 2 respectively (p=0.31). At 6 years of follow-up, the single-procedure off-AAD success rate was 19 (17.6%) in group 1 and 231 (53.4%) in group 2 (p<0.001) Conclusion: In our study patients with LSPAF and metabolic syndrome, standard ablation plus ablation of all detectable non-PV triggers during the first procedure was demonstrated to be significantly more effective in achieving long-term arrhythmia-free survival compared to standard ablation alone.