Recurrent Post-Ablation Paroxysmal Atrial Fibrillation Shares Substrates With Persistent Atrial Fibrillation. An 11-Center Study

Junaid A B Zaman, Tina Baykaner, Paul Clopton, Vijay Swarup, Robert C. Kowal, James P. Daubert, John D. Day, John Hummel, Amir A. Schricker, David E. Krummen, Moussa Mansour, Gery F. Tomassoni, Kevin R. Wheelan, Mohan Vishwanathan, Shirley Park, Paul J. Wang, Sanjiv M. Narayan, John Miller

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to determine the mechanistic overlap between paroxysmal and persistent forms of atrial fibrillation (AF), focusing on AF sources as a classification approach. Background: The role of AF substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. Methods: In 175 patients at 11 centers, we compared AF substrates in both atria using 64-pole basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF. Results: Sources were seen in all patients. More patients with de novo PAF (78.0%) had sources near pulmonary veins (PVs) than patients with redo PAF (47.4%; p = 0.005) or persistent AF (46.9%; p = 0.001). The total number of sources per patient (p = 0.444), and number of non-PV sources (p = 0.701) were similar between groups, indicating that redo PAF patients had residual non-PV sources after elimination of PV sources by prior PVI. Structurally, left atrial size did not separate de novo from redo PAF (49.5 ± 9.5 mm vs. 49.0 ± 7.1 mm; p = 0.956) but was larger in patients with persistent AF (55.2 ± 8.4 mm; p = 0.001). Conclusions: Patients with PAF despite prior PVI show electrical substrates that resemble persistent AF more closely than patients with PAF at first ablation. Notably, these subgroups of PAF are indistinguishable by structural indices. These data motivate studies of trigger versus substrate mechanisms for patients with recurrent PAF after PVI.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - May 16 2016

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Atrial Fibrillation
Pulmonary Veins
Veins
Catheters

Keywords

  • Ablation
  • Atrial fibrillation
  • Sources

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Recurrent Post-Ablation Paroxysmal Atrial Fibrillation Shares Substrates With Persistent Atrial Fibrillation. An 11-Center Study. / Zaman, Junaid A B; Baykaner, Tina; Clopton, Paul; Swarup, Vijay; Kowal, Robert C.; Daubert, James P.; Day, John D.; Hummel, John; Schricker, Amir A.; Krummen, David E.; Mansour, Moussa; Tomassoni, Gery F.; Wheelan, Kevin R.; Vishwanathan, Mohan; Park, Shirley; Wang, Paul J.; Narayan, Sanjiv M.; Miller, John.

In: JACC: Clinical Electrophysiology, 16.05.2016.

Research output: Contribution to journalArticle

Zaman, JAB, Baykaner, T, Clopton, P, Swarup, V, Kowal, RC, Daubert, JP, Day, JD, Hummel, J, Schricker, AA, Krummen, DE, Mansour, M, Tomassoni, GF, Wheelan, KR, Vishwanathan, M, Park, S, Wang, PJ, Narayan, SM & Miller, J 2016, 'Recurrent Post-Ablation Paroxysmal Atrial Fibrillation Shares Substrates With Persistent Atrial Fibrillation. An 11-Center Study', JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2016.10.006
Zaman, Junaid A B ; Baykaner, Tina ; Clopton, Paul ; Swarup, Vijay ; Kowal, Robert C. ; Daubert, James P. ; Day, John D. ; Hummel, John ; Schricker, Amir A. ; Krummen, David E. ; Mansour, Moussa ; Tomassoni, Gery F. ; Wheelan, Kevin R. ; Vishwanathan, Mohan ; Park, Shirley ; Wang, Paul J. ; Narayan, Sanjiv M. ; Miller, John. / Recurrent Post-Ablation Paroxysmal Atrial Fibrillation Shares Substrates With Persistent Atrial Fibrillation. An 11-Center Study. In: JACC: Clinical Electrophysiology. 2016.
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abstract = "Objectives: The purpose of this study was to determine the mechanistic overlap between paroxysmal and persistent forms of atrial fibrillation (AF), focusing on AF sources as a classification approach. Background: The role of AF substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. Methods: In 175 patients at 11 centers, we compared AF substrates in both atria using 64-pole basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF. Results: Sources were seen in all patients. More patients with de novo PAF (78.0{\%}) had sources near pulmonary veins (PVs) than patients with redo PAF (47.4{\%}; p = 0.005) or persistent AF (46.9{\%}; p = 0.001). The total number of sources per patient (p = 0.444), and number of non-PV sources (p = 0.701) were similar between groups, indicating that redo PAF patients had residual non-PV sources after elimination of PV sources by prior PVI. Structurally, left atrial size did not separate de novo from redo PAF (49.5 ± 9.5 mm vs. 49.0 ± 7.1 mm; p = 0.956) but was larger in patients with persistent AF (55.2 ± 8.4 mm; p = 0.001). Conclusions: Patients with PAF despite prior PVI show electrical substrates that resemble persistent AF more closely than patients with PAF at first ablation. Notably, these subgroups of PAF are indistinguishable by structural indices. These data motivate studies of trigger versus substrate mechanisms for patients with recurrent PAF after PVI.",
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T1 - Recurrent Post-Ablation Paroxysmal Atrial Fibrillation Shares Substrates With Persistent Atrial Fibrillation. An 11-Center Study

AU - Zaman, Junaid A B

AU - Baykaner, Tina

AU - Clopton, Paul

AU - Swarup, Vijay

AU - Kowal, Robert C.

AU - Daubert, James P.

AU - Day, John D.

AU - Hummel, John

AU - Schricker, Amir A.

AU - Krummen, David E.

AU - Mansour, Moussa

AU - Tomassoni, Gery F.

AU - Wheelan, Kevin R.

AU - Vishwanathan, Mohan

AU - Park, Shirley

AU - Wang, Paul J.

AU - Narayan, Sanjiv M.

AU - Miller, John

PY - 2016/5/16

Y1 - 2016/5/16

N2 - Objectives: The purpose of this study was to determine the mechanistic overlap between paroxysmal and persistent forms of atrial fibrillation (AF), focusing on AF sources as a classification approach. Background: The role of AF substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. Methods: In 175 patients at 11 centers, we compared AF substrates in both atria using 64-pole basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF. Results: Sources were seen in all patients. More patients with de novo PAF (78.0%) had sources near pulmonary veins (PVs) than patients with redo PAF (47.4%; p = 0.005) or persistent AF (46.9%; p = 0.001). The total number of sources per patient (p = 0.444), and number of non-PV sources (p = 0.701) were similar between groups, indicating that redo PAF patients had residual non-PV sources after elimination of PV sources by prior PVI. Structurally, left atrial size did not separate de novo from redo PAF (49.5 ± 9.5 mm vs. 49.0 ± 7.1 mm; p = 0.956) but was larger in patients with persistent AF (55.2 ± 8.4 mm; p = 0.001). Conclusions: Patients with PAF despite prior PVI show electrical substrates that resemble persistent AF more closely than patients with PAF at first ablation. Notably, these subgroups of PAF are indistinguishable by structural indices. These data motivate studies of trigger versus substrate mechanisms for patients with recurrent PAF after PVI.

AB - Objectives: The purpose of this study was to determine the mechanistic overlap between paroxysmal and persistent forms of atrial fibrillation (AF), focusing on AF sources as a classification approach. Background: The role of AF substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. Methods: In 175 patients at 11 centers, we compared AF substrates in both atria using 64-pole basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF. Results: Sources were seen in all patients. More patients with de novo PAF (78.0%) had sources near pulmonary veins (PVs) than patients with redo PAF (47.4%; p = 0.005) or persistent AF (46.9%; p = 0.001). The total number of sources per patient (p = 0.444), and number of non-PV sources (p = 0.701) were similar between groups, indicating that redo PAF patients had residual non-PV sources after elimination of PV sources by prior PVI. Structurally, left atrial size did not separate de novo from redo PAF (49.5 ± 9.5 mm vs. 49.0 ± 7.1 mm; p = 0.956) but was larger in patients with persistent AF (55.2 ± 8.4 mm; p = 0.001). Conclusions: Patients with PAF despite prior PVI show electrical substrates that resemble persistent AF more closely than patients with PAF at first ablation. Notably, these subgroups of PAF are indistinguishable by structural indices. These data motivate studies of trigger versus substrate mechanisms for patients with recurrent PAF after PVI.

KW - Ablation

KW - Atrial fibrillation

KW - Sources

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