Epicardial Focal Electrocardiography Over Pulmonary Veins And Effectiveness Of Surgical Ablation Of Persistent Atrial Fibrillation
Grzegorz Suwalski1, Jakub Mróz1, Robert Wierzbowski2, Kamil Kaczejko1, Robert Emery3, Przemysław Szałański1, Leszek Gryszko1, Andrzej Cwetsch2, Andrzej Skrobowski2.
1Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland, 2Department of Cardiology, Military Institute of Medicine, Warsaw, Poland, 3Department of Cardiac Surgery, St Josephs Hospital, St. Paul, MN, USA.
OBJECTIVE: In patients referred to off-pump CABG and increased operative risk pulmonary vein isolation (PVI) may be used in patients with persistent atrial fibrillation (AF) as alternative to Cox MAZE procedure. However, success rate of PVI in persistent AF is limited. Study aimed to assess the impact of recordings of epicardial focal PVs ECG on early antiarrhythmic outcomes after surgical off-pump ablation (PVI) of persistent AF.
METHODS: There were 140 PVs mapped in 34 cases undergoing off-pump CABG mapped with use of sensing-pacing probe. In all patients PVI was confirmed with bidirectional conduction block assessment. Composite study end-point consisted of need for electrical cardioversion due to in-hospital AF recurrence, the presence of AF at hospital discharge and after 3 months in 24-hours Holter ECG study.
RESULTS: Four main types of electrical signals were recorded over PVs: sinus rhythm signal, focal trigger activity, fibrillation wavelet and far field signal (FF). Composite end-point occurred in 61% of patients with epicardial FF signal recorded over at least one PV versus in 25% of patients with FF signal recorded over none of PVs (p=0.04). Presence of epicardial FF signal in at least one PV increased the risk of composite end-point occurrence (OR 3; p=0.04). Average number of PVs with epicardial FF signal recorded was significantly higher in patients with positive end-point (2.2 +/- 1.4) in comparison to group with no early AF recurrence (1.3 +/- 1.2; p=0.04). Composite end-point occurred in 86% of patients in whom epicardial far field signal was recorded over all PVs and in 39% of rest study population (p=0.03). Epicardial recording of FF signal over all PVs increased the risk of composite study end-point occurrence (OR 1.5; p=0.02).
CONCLUSIONS: Far field signal recorded over PVs with intraoperative epicardial focal ECG is related with worsen early outcomes after surgical PVI in patients with persistent AF.
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