Author + information
- Received July 6, 2015
- Revision received November 30, 2015
- Accepted December 27, 2015
- Published online April 1, 2016.
- Han S. Lim, MBBS, PhDa,
- Arnaud Denis, MDa,b,
- Melissa E. Middeldorpd,
- Dennis H. Lau, MBBS, PhDd,
- Rajiv Mahajan, MD, PhDd,
- Nicolas Derval, MDa,b,
- Jean-Paul Albenque, MDc,
- Serge Boveda, MDc,
- Stephan Zellerhoff, MDa,
- Seigo Yamashita, MDa,
- Benjamin Berte, MDa,
- Saagar Mahida, MBChBa,
- Yuki Komatsu, MDa,
- Matthew Daly, MBChBa,
- Laurence Jesel, MDa,
- Carole Pomier, PhDa,b,
- Valentin Meillet, MSca,b,
- Remi Dubois, PhDa,b,
- Sana Amraoui, MDa,b,
- Ashok Shah, MDa,
- Frédéric Sacher, MDa,b,
- Hubert Cochet, MDa,b,
- Mélèze Hocini, MDa,b,
- Pierre Jaïs, MDa,b,
- Prashanthan Sanders, MBBS, PhDd and
- Michel Haïssaguerre, MDa,b,∗ ()
- aHôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen Bordeaux II, France
- bINSERM U1045 – L’Institut de Rythmologie et Modélisation Cardiaque LIRYC, Bordeaux, France
- cClinique Pasteur, Toulouse, France
- dCentre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- ↵∗Reprint requests and correspondence:
Dr. Michel Haïssaguerre, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 Bordeaux-Pessac, France.
Objectives This study sought to characterize the clinical characteristics, atrial substrate, and prognosis in a subgroup of patients with persistent atrial fibrillation (AF) from the onset (PsAFonset).
Background Patients with AF frequently progress from trigger-driven paroxysmal arrhythmias to substrate-dependent persistent arrhythmias.
Methods Patients referred for persistent AF (PsAF) ablation were enrolled from 3 centers. Consecutive patients with PsAFonset (n = 129) were compared with patients with PsAF that progressed from paroxysmal AF (n = 231). In addition, 90 patients (30 patients with PsAFonset and 60 control subjects) were studied with noninvasive mapping to characterize the AF drivers. The degree of fractionation and endocardial voltages were assessed invasively.
Results Patients with PsAFonset were younger (p = 0.047) and more obese (p < 0.001); there were more men (p = 0.034), more patients with hypertension (p = 0.044), and these patients had larger left (p < 0.05) and right atria (p < 0.05). Baseline AF cycle length was shorter in the PsAFonset group (p < 0.01); the degree of fractionation was higher (p < 0.001 for both atria), and the endocardial voltage was lower (p < 0.05 for both atria). Patients with PsAFonset had higher a number of re-entrant driver regions (p < 0.001) and extrapulmonary vein regions that had re-entrant drivers (p < 0.05), whereas control subjects displayed more focal driver regions (p = 0.029). The acute AF termination rate was lower in the PsAFonset group (42% vs. 81%; p < 0.001). During a mean follow-up of 17 ± 11 months from the last procedure, patients with PsAFonset had significantly higher AF, atrial tachycardia (AT), and AF/AT recurrence rates (p < 0.01).
Conclusions Patients with PsAFonset represent a distinct subgroup defined by specific demographics, underlying diffuse biatrial substrate disease, and worse clinical outcome. The findings highlight the importance of defining criteria for early detection of atrial substrate disease.
This work was supported by the Agence Nationale de la Recherche (ANR) under grant ANR-10-IAHU-04, ANR Tempo, Leducq Foundation and European Frame Programme 7. Dr. Lim is supported by the Neil Hamilton Fairley Early Career Fellowship from the National Health and Medical Research Council of Australia. Dr. Lau is supported by a Postdoctoral Fellowship from the National Health and Medical Research Council of Australia. Dr. Mahajan is supported by the Leo J. Mahar Lectureship from the University of Adelaide. Dr. Sanders is supported by a Practitioner Fellowship from the National Health and Medical Research Council of Australia; is the Knapman Chair of Cardiology Research from the National Heart Foundation of Australia; is on the advisory board of and receives consulting fees from Biosense-Webster, Medtronic, and St. Jude Medical; and has received research funding from Medtronic, St. Jude Medical, Boston Scientific, Biotronik, and Sorin.
Dr. Boveda has consulted for Medtronic and Boston Scientific. Dr. Pomier is an employee of CardioInsight. Dr. Dubois is a consultant for CardioInsight. Dr. Sacher has received lecture honoraria from Biosense-Webster; and is a consultant for St. Jude Medical and Sorin. Dr. Jais is a stockholder in CardioInsight. Dr. Hocini is a stockholder in CardioInsight. Dr. Sanders is a member of the advisory board for Biosense-Webster, Medtronic, St. Jude Medical, Sanofi-Aventis, and Merck, Sharpe, and Dohme; has received consulting fees from Biosense-Webster, Medtronic, and St. Jude Medical; has received lecture fees from Biosense-Webster, Medtronic, St. Jude Medical, Boston Scientific, Merck, Sharpe, and Dohme, Biotronik, and Sanofi-Aventis; and has received research funding from Medtronic, St. Jude Medical, Boston Scientific, Biotronik, and Sorin. Dr. Haissaguerre is a stockholder in CardioInsight. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 6, 2015.
- Revision received November 30, 2015.
- Accepted December 27, 2015.
- 2016 American College of Cardiology Foundation