Abstract 9703: Factors of Atrial Fibrillation in Patients with History of Paroxysmal Supraventricular Tachycardia

Abstract

Background: Patients with history of paroxysmal supraventricular tachycardia (PSVT) have a higher risk of atrial fibrillation (AF) than patients without PSVT. The purpose of the study was to evaluate the incidence of AF in patients seen for PSVT and to look for the factors that could favour AF. Population: 1187 patients, 458 males (39%), 729 females (61%), mean age was 50±19 years were studied between 1980 and 2010 for PSVT confirmed by electrophysiological study (EPS). Patients with anterograde conduction through an accessory pathway (AP) were excluded. Methods: History of spontaneous AF was noted. Clinical factors and electrophysiological factors were collected. Patients with AF (group I) and without AF (group II) were compared. PSVT ablation was performed in 648 patients. Mean follow-up was 4.48±4.9 years. Results: 61 patients developed documented paroxysmal or permanent AF or atrial flutter (5%). They were older than patients without AF (59±13 vs 49±19 years, p< 0.0005), were more frequently men (59% vs 37%) (p<0.002), had more frequently prior AF (24.5% vs 0.5%)(< 0.00000) and associated heart disease (18% vs 5%) (p<0.004). There were no differences at EPS concerning the mechanism of re-entry: 13% of the group I patients and 18 % from the group II had a concealed AP (NS); 87 % of the group I patients and 82 % of the group II patients had typical or atypical AV nodal re-entrant tachycardia (NS). AF induction or occurrence during EPS was more frequent in group I patients (31%) than in group II patients (9%) (p<0.00000). Multivariate analysis showed age, male gender, prior AF, heart disease and atrial vulnerability during EPS were independent predictors of AF. 52.4% of the group I patients and 54.7% from the group II underwent a successful procedure of radiofrequency ablation after EPS. Univariate comparison between both groups suggests no effect of PSVT ablation on the incidence of AF. Conclusions: The incidence of AF was 5% in 1187 patients consecutively admitted for PSVT and electrophysiological study. The risk of AF was correlated with the classical factors of AF: male gender, age, prior AF and the presence of heart disease. AF induction was a risk factor of AF. There was no correlation between the mechanism of reentry and the risk of AF. PSVT ablation did not prevent AF.