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Surface ECG of AF cycle length predictive of procedural success for catheter ablation in persistent AF
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A pre-procedural surface electrocardiogram of atrial fibrillation cycle length was predictive of which patients may have sinus rhythm restored by catheter ablation in persistent and long-term atrial fibrillation.
Researchers enrolled 90 patients with long-standing persistent AF who underwent ECGs before the ablation procedures. The procedural endpoint was the termination of long-standing persistent AF with catheter ablation, and success was defined as the clinical endpoint of maintenance of sinus rhythm without antiarrhythmic drug treatment for more than 12 months after the procedure.
Persistent AF was terminated by ablation in 84% of the patients. The duration of AF was also shorter (P<.0001), the surface ECG AF cycle length was longer (P<.0001) and the left atrium was smaller (P<.01) in the patients who had their AF terminated with ablation vs. those who did not. The surface ECG AF cycle length was also an independent predictor of long-lasting persistent AF termination, with an area under the curve of 0.880 (95% CI, 0.795-0.939). Multivariate analysis suggested that ECG AF cycle length (P<.01) and AF duration (P<.05) were predictive of clinical success of persistent AF ablation. In addition, the maintenance of sinus rhythm was associated with a shorter duration of continuous AF (P<.0001) and a smaller left atrium (P<.05).
“This study confirms that long-lasting persistent AF can be terminated and potentially cured by catheter ablation,” the researchers concluded. “The surface ECG AF cycle length independently predicts procedural termination of persistent AF, and both the surface ECG AF cycle length and the duration of continuous AF … could help with patient selection for catheter ablation of long-lasting persistent AF.”
Matsuo S. J Am Coll Cardiol. 2009;54:788-795.