Objectives: To verify predictors of late arrhythmia recurrence in pts underwent de novo circumferential and linear ablation of atrial fibrillation (Afib) using 3D mapping system based on three years of follow-up period.
Materials and methods 214 patients ( an average age – 53.65 ± 11,5 years, ranged - 22 to 76 years) underwent an index RFA of Afib (43 women). There were 84 paroxysmal (39.25%), 63 persistent (29.44%) and 67 long-lasting persistent (31.31%) Afib pts involved. According to the atrial arrhythmia recurrence at the follow-up period all patients were divided into two groups: blanking period recurrence – 25 pts and late atraial arrhythmia recurrence (up to the 3 years of follow-up) - 52 pts. In 137 pts there was no any recurrence of arrhythmia observed within the 3 years after de novo RFA. Average TT ECHO parameters at the beginning of protocol (214 pts): LV EDD - 55.4 ± 9.5 mm, LV ESD - 37 ± 8.6 mm, LV ESV - 63.57 ± 35.10 ml, LV EDV – 158.14 ± 44.92 ml, EF 60.76 ± 13.54%, LA - 43.9 ± 7.8 mm. Valves characteristics: in 165 pts mitral valve was intact, prolapsed mitral valve was diagnosed in 41 pts. Mild mitral regurgitation (MR) was verified in 108 patients, severe MR - in 87 pts and total MR in 19 pts. Although in 194 pts tricuspid valve was intact mild tricuspid regurgitation (TR) was verified in 125 patients, severe TR - in 74 pts and total TR in 11 pts. In 205 pts aortic valve (AoV) was intact. Mild AoV regurgitation was verified in 40 patients, severe regurgitation - in 7 pts and AoV stenosis in 2 pts. ECG findings: anterior branch hemiblock was noted in 8 pts (3,7%), left bundle branch block - in 4 pts (2%), right bundle branch block - in 9 pts (4,2%). We used nonparametric statistics methods to estimate value of ECHO and ECG parameters to predict recurrence of arrhythmia.
Results: Three-year efficiency of single RFA procedure was 79%. In patients with atrial arrhythmia recurrence initial TT ECHO parameters exceeded following characteristics: LA - 44.7 ± 5 mm, LV ESD - 37.1 ± 5.9 mm, LV EDD - 57.6 ± 7.2 mm. EF less then 57% marked recurrent arrhythmia time coarse. Intraventricular conduction block as well as severe mitral or tricuspid regurgitation is associated with worse prognosis while mitral prolapse consisted with mild regurgitation predicts three-year arrhythmia-free outcome.
Conclusions: nonparametric analysis of ECHO and ECG parameters can predict arrhythmia recurrence in pts underwent an index Afib ablation within the 3 years of follow-up.