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Extraatrial Disease in Patients with “Lone” Atrial Fibrillation

Aims: Lone atrial fibrillation (LAF) is considered by some to be a primary atrial electrophysiologic disorder. However, we have frequently observed evidence of “extraatrial” diseases - atherosclerosis and associated metabolic disorders - in our LAF patients. We sought to characterize and quantify extraatrial disease burden in LAF patients, and to correlate this burden with features of the arrhythmia including pattern (paroxysmal versus persistent) and response to catheter ablation.          

Methods and Results: Forty-six consecutive patients with non-familial LAF underwent assessment for evidence of atherosclerosis (computed tomographic vascular calcification and elevated arterial pulse wave velocity) and associated metabolic diseases (dyslipidemia, insulin resistance and inflammation), and then catheter ablation.  

The cohort had a significant incidence of atherosclerosis (57%) and metabolic (70%) diseases. Patients with persistent AF tended to have a greater extraatrial disease burden than those with paroxysmal AF. A significant inverse relationship between the rate of ablation success and extraatrial disease burden was demonstrated.

Conclusions: Extraatrial disease was common in this LAF cohort. Correlations between extraatrial disease burden and features of the arrhythmia would, if verified, challenge the notion that LAF is a “primary” electrophysiologic disorder.     

Credits: Jason Confino; Daniel Edmundowicz; Joan M. Lacomis; Iclal Ocak; Christopher R. Deible; David Schwartzman

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