Electrophysiological predictors of susceptible atrial substrate for the onset and recurrence of atrial fibrillation.

IF 2.1 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-11-29 DOI:10.1007/s10840-024-01956-y

Cevher Ozcan, Zaid Aziz, Michael Mayer, Amrish Deshmukh, Hatem Al Kassem, Gaurav Upadhyay, Andrew Beaser, Maryam Emami

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Abstract

Background: The atrial electroanatomic substrate is an essential component in the pathogenesis of atrial fibrillation (AF). However, the electrophysiological markers of susceptible atria for AF are not well-characterized. This study aimed to assess atrial conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) as predictors of initiation and recurrence of AF after successful ablation.

Methods: We studied all consecutive patients who underwent electrophysiological study and catheter ablation for AF (study group) or atrioventricular nodal reentrant tachycardia (AVNRT) (control group) from 2013 to 2018. Atrial conduction indices were measured on ECG and EGM during the electrophysiology study. Clinical data was obtained from the medical record.

Results: A total of 387 patients with AF (mean age 63 years, 31% female) were studied and compared to 94 patents in control group. The initiation of AF was associated with significant prolongation of atrial conduction indices on ECG and EGM (p < 0.05). During a mean follow up of 5 ± 2 years, recurrence of AF (48%) after successful ablation occurred in patients with prolonged P wave duration, left atrial (LA) conduction interval, proximal to distal coronary sinus (pCS-dCS) interval, and P wave to dCS interval (p < 0.05). Machine learning modeling determined that pCS-dCS interval, QRS duration, and LA duration in leads V1 and II are most impactful conduction indices in association with AF recurrence.

Conclusion: Prolonged atrial conduction intervals, particularly LA (pCS-dCS), indicate susceptible substrate for the onset and the recurrence of AF after ablation. LA conduction indices can facilitate early detection and management of AF.

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易感心房底物的电生理预测心房颤动的发生和复发。

背景：心房电解剖底物是心房颤动（AF）发病机制的重要组成部分。然而，AF易感心房的电生理指标尚不明确。本研究旨在评估体表心电图（ECG）和心内心电图（EGM）上的心房传导指数作为房颤消融成功后发生和复发的预测指标。方法：我们研究了2013年至2018年期间所有因房颤（研究组）或房室结性心动过速（AVNRT）连续接受电生理研究和导管消融的患者（对照组）。电生理研究期间，分别在心电图和心电图上测量心房传导指数。临床资料来源于病历。结果：共纳入387例房颤患者（平均年龄63岁，女性31%），对照组94例。房颤的起始与ECG和EGM上心房传导指数的显著延长相关(p结论：心房传导间隔的延长，特别是LA (pCS-dCS)，提示房颤消融后发病和复发的易感底物。LA传导指标有助于房颤的早期发现和治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Interventional Cardiac Electrophysiology 医学-心血管系统

CiteScore

4.30

自引率

11.10%

发文量

320

审稿时长

4-8 weeks

期刊介绍： The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.