Author + information
- Received March 22, 2017
- Revision received August 24, 2017
- Accepted August 28, 2017
- Published online January 15, 2018.
- Sandeep Prabhu, MBBSa,b,c,d,
- Aleksandr Voskoboinik, MBBSa,b,c,d,
- Alex J.A. McLellan, MBBS, PhDa,b,c,d,
- Kah Y. Peck, MBBSa,
- Bhupesh Pathik, MBBSc,d,
- Chrishan J. Nalliah, MBBSc,d,
- Geoff R. Wong, MBBSc,d,
- Sonia M. Azzopardi, CC Bc RNa,b,
- Geoffrey Lee, MBChB, PhDc,
- Justin Mariani, MBBS, PhDa,b,
- Liang-Han Ling, MBBS, PhDa,b,c,d,
- Andrew J. Taylor, MBBS, PhDa,b,
- Jonathan M. Kalman, MBBS, PhDc,d and
- Peter M. Kistler, MBBS, PhDa,b,d,∗ ()
- aDepartment of Cardiology, Alfred Hospital, Victoria, Australia
- bBaker IDI Heart and Diabetes Institute, Victoria, Australia
- cCardiology Department, Royal Melbourne Hospital, Victoria, Australia
- dFaculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Prof. Peter M. Kistler, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
Objectives This study sought to characterize the biatrial substrate in heart failure (HF) and persistent atrial fibrillation (PeAF).
Background Atrial fibrillation (AF) and HF frequently coexist; however, the contribution of HF to the biatrial substrate in PeAF is unclear.
Methods Consecutive patients with PeAF and normal left ventricular (NLV) systolic function (left ventricular ejection fraction [LVEF] >55%) or idiopathic cardiomyopathy (LVEF ≤45%) undergoing AF ablation were enrolled. In AF, pulmonary vein (PV) cycle length (PVCL) was recorded via a multipolar catheter in each PV and in the left atrial appendage for 100 consecutive cycles. After electrical cardioversion, biatrial electroanatomic mapping was performed. Complex electrograms, voltage, scarring, and conduction velocity were assessed.
Results Forty patients, 20 patients with HF (mean age: 62 ± 8.9 years; AF duration: 15 ± 11 months; LVEF: 33 ± 8.4%) and 20 with NLV (mean age: 59 ± 6.7 years; AF duration: 14 ± 9.1 months; p = 0.69; mean LVEF: 61 ± 3.6%; p < 0.001), were enrolled. HF reduced biatrial tissue voltage (p < 0.001) with greater voltage heterogeneity (p < 0.001). HF was associated with significantly more biatrial fractionation (left atrium [LA]: 30% vs. 9%; p < 0.001; right atrium [RA]: 28% vs. 11%; p < 0.001), low voltage (<0.5 mV) (LA: 23% vs. 6%; p = 0.002; RA: 20% vs 11%; p = 0.006), and scarring (<0.05 mV) in the LA (p = 0.005). HF was associated with a slower average PVCL (185 vs. 164 ms; p = 0.016), which correlated significantly with PV antral bipolar voltage (R = −0.62; p < 0.001) and fractionation (R = 0.46; p = 0.001).
Conclusions HF is associated with significantly reduced biatrial tissue voltage, fractionation, and prolongation of PVCL. Advanced biatrial remodeling may have implications for invasive and noninvasive rhythm control strategies in patients with AF and HF.
This research has been supported in part by the Victorian Government’s Operational Infrastructure Funding. Drs. Prabhu, Ling, McLellan, Voskoboinik, Nalliah, and Pathik have received funding from the Australian National Health and Medical Research Council (NHMRC) and/or the National Heart Foundation of Australia. Drs. Prabhu and McLellan have also received funding from the Baker Heart and Diabetes Research Institute (Melbourne, Australia). Drs. Kalman, Lee, and Kistler have been supported in part by the NHMRC. Dr. Kalman has served on the advisory board of Biosense Webster; and has received research and fellowship support from Medtronic, Abbott, and Biosense Webster. All other authors have reported that they have no relationships relevant to this paper to disclose. Katia Zeppenfeld, MD, served as Guest Editor for this article.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 22, 2017.
- Revision received August 24, 2017.
- Accepted August 28, 2017.
- 2018 American College of Cardiology Foundation
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