Background: Recurrence after pulmonary vein (pv) isolation could reflect either pv triggers or the presence of non pv triggers. We sought to identify pv versus other triggers on the basis of simple ECG criteria detected on the remote monitoring and confirmed at the repeat procedure. Methods: The baseline ECG and remote monitoring of 650 consecutive patients undergoing their redo ablation for atrial fibrillation were collected. Patients were considered if they had premature atrial contractions (PACs) on their monitoring only if no conduction abnormalities were present and if all PACs were conducted. Of them 507 (78%) met the inclusion criteria. All patients underwent pv antrum isolation and ablation of non-PV triggers as disclosed by isoproterenol challenge test up to 20 mcg/min. The PACs coupling interval and PR duration was measured, analyzed and compared to baseline PR interval. Sensitivity, specificity, and predictive values were calculated. results: Of the 507 patients with PACs (34% PAF, 26% persistent and 40% long-standing AF) included in the analysis, short-PR PACs were observed in 350 (69%) patients. Non-PV triggers were mapped to coronary sinus (74%) and LA appendage (68%); other non-PV foci were LA Septum (32%), mitral valve annulus (7%), crista terminalis (9%) and superior vena cava (38%). PV reconnection occurred in 38% of patients. Short-PR PACs were strongly associated with triggers from the CS or LAA origin. At the multivariate logistic model, the presence of short-PR PACS predicted CS/LAA triggers in 92% of the times (positive predictive value); the negative predictive value was 100%. The model had 100% sensitivity and 88% specificity (area under curve 0.94.). On the other hand, the presence of long-PR PACS were never associated with LAA and CS triggers and usually reflected PV triggers, SVC and right atrial triggers. Conclusion: PACs with a PR interval shorter than in sinus rhythm on remote monitoring, identify patients with left atrial appendage and coronary sinus triggers. On the other hand PACs with a PR interval longer than in sinus rhythm identify triggers from the pvs or the right atrium. This information could be clinically relevant in planning patient specific procedures.
|Titolo:||Short PR versus long PR premature atrial contractions on remote monitoring as predictor of non pulmonary vein triggers following unsuccessful atrial fibrillation ablation|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
|Data di pubblicazione:||17-mar-2015|
|Enti collegati al convegno:||American College of Cardiology|
|Digital Object Identifier (DOI):||10.1016/S0735-1097(15)60424-7|
|Appare nelle tipologie:||01 - Articolo su periodico|