DOI: 10.1161/circ.148.suppl_1.17638 ISSN: 0009-7322

Abstract 17638: Left Atrial Scar Burden Among Patients With Persistent Atrial Fibrillation Undergoing Catheter Ablation and Its Association With Patient Risk Factors and Risk of Recurrence

Matthew Pulaski, Christopher Thorne, Ian Ling, Allyson Varley, Victor Nauffal, Jose Osorio, Brahim Redouane, Esseim Sharma, Andrew Zadeh, Matthew J Singleton, Paul Zei, Ivan C Ho, Anil Rajendra, Junaid Zaman
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Left atrial (LA) scar at time of catheter ablation (CA), assessed by bipolar voltage <0.5mV may indicate more advanced AF substrate. It is not known which risk factors are associated with scar burden and whether this is linked to worse clinical outcomes.

Hypothesis: We hypothesized that patient demographics and comorbidities are associated with greater scar burden at time of CA and predispose to AF recurrence.

Methods: The Real-AF registry is a prospective, observational, multicenter registry of patients undergoing CA with follow-up at 6 and 12 months. LA scar burden was calculated from CARTO as total % LA area < 0.50mV bipolar using the Pentaray catheter at first CA for persistent AF. We evaluated 1503 patients among this cohort using logistic regression modeling of age, sex, CHA2DS2-VASc and LVEF <= 35%, BMI and their association with LA scar burden categorized as 0 to 5% vs >= 6%. In 783 patients with 12-month clinical outcomes a Kaplan-Meier estimator was used to analyze risk of AF recurrence in these two cohorts.

Results: Each additional year in age is associated with 1.07 greater odds (p<0.001, 95% CI=1.05, 1.08) of scar area >= 6%. Women had 2.08 greater odds (p<0.001, 95% CI=1.63, 2.65) of abnormal scar area compared to men, while patients with CHF had 1.67 greater odds (p<0.001, 95% CI=1.30, 2.16). Patients with LA scar burden >= 6% experienced significantly higher recurrence of AF compared to those with a lower scar burden (HR=1.8, p=0.0094) including after controlling for operator-specific effects (HR=1.9, p=0.0088), see figure 1.

Conclusions: In a large multicenter registry of persistent AF patients undergoing CA, LA scar >=6% was associated with female sex, greater age, and CHF. An increased scar burden is associated with worse 12 month clinical outcomes from CA.

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