B-PO02-093 LOCALIZED ABNORMAL ATRIAL ELECTROGRAMS WAS ASSOCIATED WITH POST-ABLATION RECURRENCE IN PATIENTS WITH LONG-STANDING PERSISTENT ATRIAL FIBRILLATION AND SEVERELY ENLARGED, PRESERVED MYOCARDIAL-VOLTAGE ATRIA

Abstract

Patients with long-standing persistent atrial fibrillation (LSPAF) and severely enlarged atria are generally resistant to treatment. Enlarged atria with preserved myocardial-voltage (pseudo-normal atria) are occasionally identified even in such patients. This population has not described well. To investigate electrophysiologic characteristics of these patients. Patients, with LSPAF (AF persisted >1year), severely enlarged atria (LA diameter [LAD]>50mm) and substrate map of left- and right atria without low-voltage(<0.5mV) area obtained after the isolation of pulmonary veins (PVI) and cavo-tricuspid isthmus (CTI) ablation, were retrospectively investigated. Patients with structural heart disease were excluded. Ten patients (AF duration; 4.3±4.5years, LAD; 52±2mm) were investigated. Five showed localized abnormal atrial electrograms (LAAEs; amplitude of 0.74±0.14mV) even in preserved-voltage atria. The representative case of preserved voltage atria with LAAEs is shown in Figure (Left panel). Isoproterenol infusion revealed the presence of Non-PV AF foci (NPVAF) at the LAAE site in 3 patients. NPVAF ablation was additionally performed only in the 1 patient and the remaining 9 received no adjunctive ablation. During follow-up, AF recurred in 3 of 5 patients (60%) with LAAEs, however, no recurrence in the others (p = 0.022, Log-Rank test. Right panel of Figure). The presence of LAAE was associated with NPVAF and recurrence of AF after PVI and CTI ablation, indicating a need of adjunctive ablation in LSPAF patients with pseudo-normal atria.