PO-710-02 PATIENT COMORBIDITIES AND ABLATION TECHNIQUE ARE IMPORTANT DETERMINANTS OF FIRST PASS PULMONARY VEIN ISOLATION

Abstract

First pass isolation (FPI) of the pulmonary veins (PVs) is a good predictor of durability of PV isolation and success rate of AF ablation. Systematic analysis of predictors of FPI has not previously been performed. To investigate how variations in ablation technique and patient comorbidities influence acute durable isolation during PVI. Raw data was exported from first time PVIs performed using the CARTO system for 62 consecutive patients. Cases were imported into Matlab using openEP and lesion characteristics and locations were extracted. Separate multivariate logistic regression analyses for both ablation technique and patient characteristics were performed for each vein. Left sided FPI was achieved in 42 patients (68%) and right sided FPI in 31 (50%). The commonest sites needing reinforcement were carina and anterior left superior (LS)PV on the left and the carina and posterior right inferior (RI)PV on the right (Figure). In terms of predictors of FPI for the LIPV, increased patient weight predicted reduced success (OR 0.93, p=0.018) and closer lesion-ostium distance posteriorly predicted increased success (OR 0.88, p=0.037). For the LSPV, larger atrial surface area in comparison to area ablated predicted reduced success (OR 0.83, p=0.024). For the RSPV, the presence of hypertension (OR 0.20, p=0.039) and coronary disease (OR 0.29, p=0.033) significantly reduced the chance of FPI. In addition, lower lesion-ostium distance anteriorly increased the chance of FPI (OR 0.87, p=0.024). For the RIPV, an enhanced impedance drop in the posterior (OR 1.61, p=0.004) and anterior (OR 1.12, p=0.03) segments, significantly increased success. The acute success of AF ablation in terms of FPI is affected by ablation technique and comorbidities. It seems particularly important to ablate closer to the ostium to achieve FPI in the anterior RSPV and posterior LIPV. At the posterior and anterior RIPV it is of particular importance to obtain a good impedance drop during ablation. Increased patient weight appears to increase the difficulty of isolating the LIPV while hypertension and coronary disease are associated with reduced chance of FPI at the RSPV. It is possible that the operator being mindful of these associations could increase success rates and/or durability of PVI.