Abstract 14862: Electrophysiological Predictors of Susceptible Atrial Substrate for the Onset and Recurrence of Atrial Fibrillation

• Published in: Circulation (New York, N.Y.) Vol. 148; no. Suppl_1
• Main Authors: Mayer, Michael, Aziz, Zaid, Deshmukh, Amrish, Al Kassem, Hatem, Beaser, Andrew, Upadhyay, Gaurav A, Emami, Maryam, Ozcan, Cevher
• Format: Journal Article
• Language: English
• Published: 07.11.2023
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.148.suppl_1.14862

Abstract only Introduction: Atrial electro-anatomical substrate is essential for pathogenesis of atrial fibrillation (AF). Electrophysiological markers of AF susceptibility, however, are not well characterized. Identifying markers of atrial substrate has significant clinical implications in early detection and intervention for AF or stratifying patients at higher risk of AF recurrence following ablation. Hypothesis: We hypothesized that conduction indices on surface electrocardiogram (ECG) and intracardiac electrogram (EGM) may predict susceptibility and/or AF recurrence following ablation. Methods: We studied all consecutive patients who underwent electrophysiological study and catheter ablation for AF or atrioventricular nodal reentrant tachycardia (AVNRT) from 2013 to 2018. Atrial conduction indices were measured on ECG and EGM during the electrophysiology study. We evaluated correlations between both AF and AF recurrence with conduction indices, and associations between AF recurrence and conduction indices were evaluated with univariate logistic regression analyses and machine learning. Results: The study population included 387 patients with AF (mean age 63 years, 31% female) and compared to patients with AVNRT (n=94) who were considered as a control group. AF was associated with significant prolongation of all measured surface ECG and EGM parameters (p<0.05). During a mean follow up of 5±2 years, recurrence of AF (48%) after successful ablation occurred in patient with longer P wave duration, left atrial (LA) conduction duration, proximal to distal coronary sinus (pCS-dCS) interval, and P-dCS interval (p<0.05). Prolonged P wave duration, LA duration, pCS-dCS interval, and QRS duration were predictors of AF recurrence. Machine learning modeling determined that pCS-dCS interval, QRS duration, and LA duration (lead V1 and II) were the most impactful conduction indices for AF recurrence. Conclusions: Atrial conduction indices are markers of susceptible substrate for the onset and the recurrence of AF after successful ablation. LA conduction parameters can be used for risk stratification to facilitate early detection and management of AF.