B-PO04-114 EFFECT OF SINUS NODE DYSFUNCTION ON RECURRENCE OF ATRIAL FIBRILLATION IN PATIENTS UNDERGOING PULMONARY VEIN ANTRUM ISOLATION

Abstract

Atrial Fibrillation (AF) is the most common arrhythmia. Patients with AF refractory to medical therapy undergo pulmonary vein antrum isolation (PVAI). Long term rhythm control post procedure remains a challenge. To elucidate the role of baseline sinus node dysfunction (SND) in recurrence of AF post-PVAI. Baseline, and follow-up data for patients with paroxysmal AF (PAF) undergoing PVAI at a single tertiary care center between 2004-2019 was collected. ECG and holter monitoring were done at 1, 3, 6, and 12 months post procedure. Episodes recorded during the blanking period (<3 months) were considered early (ER), while those occurring after were noted as late recurrence (LR). To assess the impact of SND, a multivariate logistic regression model was constructed. Kaplan-Meier analysis was done to examine the overall AF-free survival in each group (SND vs No-SND). Overall, 1,529 consecutive PAF patients (female: 38.2%, mean age: 60.6±10.7 years, mean follow-up time: 22.3±17.4 months, SND: 7.8%) were included in the study. Rate of ER and LR was significantly higher in patients with SND (ER: 51 (44%) vs 400(30%), P=0.002 and LR: 79 (68.1%) vs 524 (41%), P<0.001). After controlling for age, sex, diabetes, hypertension, left atrial size, and ejection fraction, SND emerged as the independent predictor of both early and late AF recurrence (ER: OR=1.8 (1.2-2.7)) and LR: OR=3.0 (1.9-4.5)). Similarly, patients with SND had significantly lower 1-year AF-Free Survival compared to those without (ER: 57% vs 70%, P<0.002 and LR: 52.5% vs 70.1%, <0.001). Sinus Node Dysfunction is an important prognostic marker for PVAI success, and AF recurrence post ablation.