Abstract 13677: Best Ablation Strategy in Patients With Coexistent Metabolic Syndrome and Long-Standing Persistent Atrial Fibrillation: Results From a Propensity-Matched Population

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A13677-A13677
• Main Authors: Mohanty, Sanghamitra, Trivedi, Chintan G, Della Rocca, Domenico G, Gianni, Carola, Canpolat, Ugur, MacDonald, Bryan, Burkhardt, John D, Sanchez, Javier, Hranitzky, Patrick, Gallinghouse, G, Al-ahmad, Amin, Horton, Rodney P, Bassiouny, Mohammed, Di Biase, Luigi, Natale, Andrea
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13677

IntroductionProcedure-outcome after catheter ablation in long-standing persistent atrial fibrillation (LSPAF) patients is reported to be highly variable with different ablation approaches. Metabolic syndrome (MS), a pro-inflammatory state, is also considered to be closely associated with recurrent AF. We evaluated the long-term outcome with different ablation strategies in patients with coexistent MS and LSPAF.MethodsConsecutive patients with LSPAF and MS undergoing their first catheter ablation were classified into two groups; group 1standard ablationPVAI extended to the entire posterior wall (PW) plus empirical isolation of superior vena cava (SVC) and group 2standard ablation+ ablation of non-PV triggers. Ablation strategy was based on operators’ discretion. In order to attenuate the between-group imbalance of the baseline covariates, a propensity score-matching technique was used resulting in 102 and 408 (14) patients in gr 1 and 2 respectively. Arrhythmia-monitoring was performed quarterly for 1 year and biannually afterwards. Long-term success was assessed off-antiarrhythmic drugs (AAD).ResultsAll patients received PVAI plus isolation of left atrial PW and SVC (standard ablation). Following the standard ablation, high-dose isoproterenol challenge (25-30 μg/min for 10-15 min) was performed in group 2 (n=408) patients to identify non-PV triggers. These were detected and ablated in LAA (277, 68%), CS (298, 73%), inter-atrial septum (119, 29%) and crista terminalis (72, 17.6%). Isoproterenol challenge was not performed in group 1 (n=102) patients. Procedural complications included 1 (0.98%) and 3 (0.73%) groin hematomas in group 1 and 2 respectively (p=NS). At the end of 2 years of follow-up, 18 (17.6%) from group 1 and 253 (62%) patients from group 2 were arrhythmia free off-AAD (p