Coronary sinus electrogram characteristics predicts termination of AF
with ablation and long-term clinical outcome.
Abstract
Introduction- Markers predicting AF termination and freedom from
AF/atrial tachycardia (AT) has been proposed. The role of CS electrogram
characteristics has not yet been evaluated. Methods- Patients undergoing
ablation for persistent AF as part of the Stochastic Trajectory Analysis
of Ranked signals mapping study were included. Novel CS electrogram
characteristics including CS cycle length variability (CLV) and CS
activation pattern stability (APS) and proportion of low voltage zones
(LVZs) were reviewed as potential predictors for AF termination on
ablation and freedom from AF/AT during follow-up. The relationship
between localized driver characteristics and CS electrogram
characteristics were also assessed. Results- Sixty-five patients were
included. AF termination was achieved in 51 patients and 80% of
patients were free from AF/AT during a follow-up of 29.5±3.7 months. CS
CLV of <30ms, CS APS of ≥30% and proportion of LVZ
<30% showed a high diagnostic accuracy in predicting AF
termination on ablation and freedom from AF/AT during follow-up (CS CLV
OR 25.6, AUC 0.91; CS APS OR 15.9, AUC 0.94; proportion of LVZs OR 21.4,
AUC 0.88). These markers were independent predictors of AF termination
on ablation and AF/AT recurrence during follow-up. Ablation of a smaller
number of drivers that demonstrate greater dominance strongly correlate
with greater CS organization. Conclusions- Novel CS electrogram
characteristics were independent predictors of AF termination and AF/AT
recurrence during follow-up. These markers can potentially aid in
predicting outcomes and guide ablation and follow-up strategies.