DOI: 10.1161/circ.148.suppl_1.16362 ISSN: 0009-7322

Abstract 16362: Does Extra-Pulmonary Triggers or Autonomic Neural Activity Affect the Rhythm Control by Anti-Arrhythmic Drugs in Patients With Post-Ablation Atrial Fibrillation Recurrence?

Hanjin Park, Daehoon Kim, Je-Wook Park, Hee Tae Yu, Tae-Hoon Kim, Jae-sun Uhm, BOYOUNG JOUNG, Moon Hyoung LEE, Chun Hwang, Hui-Nam Pak
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Although the EAST-AFNET trial demonstrated the usefulness of atrial fibrillation (AF) rhythm control, including antiarrhythmic drugs (AADs), little is known about their effect on recurred AF after catheter ablation (CA).

Hypothesis: We explored the effect of AADs depending on the presence of extra-pulmonary vein triggers (ExPVT) or post-ablation heart rate variability (HRV) in patients who recurred after AFCA.

Methods: In this retrospective analysis of a single-center cohort, we analyzed 2,036 patients who underwent de-novo AFCA, and 486 of them had recurrent AF and subsequently underwent rhythm control with AADs. We investigated the effects of the extra-pulmonary vein (PV) triggers and post-procedural 3 rd month HRV (rMSSD; cut-off determined by Youden index) on the AAD responsiveness.

Results: The post-AFCA recurrence was significantly higher in patients with ExPVT (Log-rank p<0.001, HR 1.45 [1.16-1.83], p=0.001) or higher 3 rd month post procedure HRV-rMSSD (Log-rank p<0.001, HR 1.36 [1.11-1.65], p=0.003) than their counterparts. Patients with ExPVT at de novo procedure had significantly higher 3 rd month rMSSD (15.0 [11.0-23.0] vs. 17.0 [11.0-28.0], p=0.022) and patients with high 3 rd month rMSSD showed a higher rate of ExPVT identified at the 2 nd repeat procedure (n=160, 41.0% vs. 22.2%, p=0.019). Among those patients how recurred AF after AFCA, post-AAD recurrence did not differ depending on ExPVT (Log-rank p=0.455, HR 1.12 [0.78-1.69], p=0.436) or rMSSD (Log-rank p=0.457, HR 1.16 [0.87-1.55], p=0.300). Post-AAD recurrence did not differ between class IC and III AADs (p for interaction = 0.311).

Conclusion: ExPVT and post-procedural high rMSSD are independent risk factors for post-AFCA recurrences but not for AAD response in recurred AF patients. Whether AADs may suppress ExPVT and modulate cardiac autonomic activity after post-AFCA recurrences need further investigation.

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