Abstract 14119: Association of Electrophysiologic Characteristics of Extra Pulmonary Vein Triggers With Atrial Fibrillation Recurrence

Introduction: The objective of this study was to investigate the mechanisms underlying the effects of extra pulmonary vein triggers (ExPVTs) on atrial fibrillation (AF) recurrence after catheter ablation (AFCA). We aimed to assess whether there are differences in electrophysiologic characteristics based on the location of ExPVTs and whether the location of ExPVTs is associated with AF recurrence.

Methods: Among 2,625 patients who underwent de novo AFCA and subsequently underwent isoproterenol provocation tests, ExPVTs were identified in 311 cases. We categorized the location of ExPVTs as left atrium (LA), right atrium (RA), or septum, and vascular or non-vascular origins.

Results: Patients with ExPVTs in the LA exhibited a larger LA diameter (42.2±6.8 vs. 40.4±6.9, p=0.035), a higher LA volume index (LAVI) (43.1±17.1 vs. 37.9±12.2, p=0.006), as well as significantly higher LA wall stress (193.2±106.7 vs. 154.9±74.6, p=0.001) compared to patients with ExPVTs in the RA. Multivariable logistic regression analysis revealed that male sex (p=0.032), diabetes mellitus (p=0.008), and higher LAVI (p=0.021) were associated with the presence of ExPVTs in the LA. No significant difference was observed in AF recurrence rate based on the location of ExPVTs when categorized as LA, RA, or both (Log-rank p=0.087), or when categorized as vascular versus non-vascular origin (p=0.528). However, when ExPVTs were classified as LA, RA, or septum, a significant difference in AF recurrence among the three groups was observed (p=0.047), with a higher recurrence rate in patients with ExPVTs in the LA compared to those with ExPVTs in the RA (p=0.018).

Conclusions: Categorizing the location of ExPVT as LA, RA, or septum revealed a significantly higher AF recurrence rate in patients with ExPVTs in the LA compared to those with ExPVTs in the RA.