Relationship between the left atrial and pulmonary vein effective refractory period and the development of early atrial fibrillation recurrence after radiofrequency pulmonary vein isolation. First results

Aim. To assess the relationship between the left atrial (LA) and pul­monary vein (PV) effective refractory period and the development of early atrial fibrillation (AF) recurrence after radiofrequency pul­monary vein isolation (PVI).

Material and methods. The study included 35 patients with persistent AF refractory to antiarrhythmic therapy (AAT). In all patients, LA and PV effective refractory period (ERP) was assessed, followed by radiofrequency antral PVI. Depending on the ERP values, the patients were divided into 2 groups. Group 1 (n=15) included patients with mean LA and PV ERP values ≥240 ms, while group 2 (n=20) consisted of patients with mean LA and PV ERP values <240 ms. The evaluation of early AF recurrence, depending on the obtained ERP values, was carried out in the first 3 months.

Results. We obtained following ERP values: group 1 — LA (LA ap­ pendage) 252±8,9 ms; left superior PV (LSPV) — 252±12,1 ms; left inferior PV (LIPV) — 257,3±8,15 ms; right superior PV (RSPV) — 254,6±11,3 ms; right inferior PV (RIPV) — 260±9,05 ms; group 2 — LA 230±12,1 ms; LSPV — 205±10,5 ms; LIPV — 186,6±22,05 ms; RSPV — 212,2±14 ms; RIPV — 218,8±11,1 ms. During the 3-month follow-up of group 1 patients, there were no recurrences after PVI. Group 2 had 7 early AF recurrences. Correlation analysis revealed a significant inversely proportional relationship (-0,349; p=0,03) between ERP values and the recurrence rate in the groups.

Conclusion. The first results demonstrate an inversely proportional relationship between the mean PV and LA ERP and the development of early AF recurrence, which makes it possible to consider the PV and LA ERP <240 ms as a likely predictor of early AF recurrence. However, this fact requires the study continuation with an increase in the sample and an appropriate statistical analysis.

1. Kirchhof P, Benussi S, Kotecha D, et al. 2016 Esc Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the ESC. Developed with the special contribution of the EHRA of the ESC. Endorsed by the ESO. Eur Heart J. 2016;37(38):2893-962. doi:10.1093/eurheartj/ehw210.2.

2. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-66. doi:10.1056/NEJM199809033391003.

3. Pappone C, Rosanio S, Oreto G, et al. Circumferential radio­frequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation. Circulation. 2000; 102(21):2619-28. doi:10.1161/01.cir.102.21.2619.

4. Wilber DJ, Pappone C, Neuzil P, et al. Comparison of antiar­rhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA. 2010;303(4):333-40. doi:10.1001/jama.2009.2029.

5. Julio J, Chierchia G-B, Chierchia C, et al. Regular atrial tachy­cardias following vein isolation for paroxysmal atrial fibrillation: a comparison between the cryoballoon and radiofrequency techniques. J Interv Card Electrophysiol. 2015;42(2):161-9. doi:10.1007/s10840-014-9961.

6. Kotanova ES, Rzaev FG, Sichinava NV, et al. Long-term re­sults of isolated electric isolation of pulmonary veins ostia by radio­frequency ablation in patients with paroxysmal and persistent forms of atrial fibrillation. Annals of Arrhythmology. 2009;6:78-86. (In Russ.)

7. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace. 2018;20(1):157-208. doi:10.1093/europace/eux275.

8. Andrade JG, Khairy P, Verma A, et al. Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2012;35(1):106-16. doi:10.1111/j.1540-8159.2011.03256.x.

9. Alipour P, Azizi Z, Pirbaglou M, et al. Defining Blanking Period Post-Pulmonary Vein Antrum Isolation. JACC. Clin Electrophysiol. 2017;3(6):568-76. doi:10.1016/j.jacep.2017.01.006.

10. O’Donnell D, Furniss SS, Dunuwille A, et al. Delayed cure despite early recurrence after pulmonary vein isolation for atrial fibrillation. Am J Cardiol. 2003;91(1):83-5. doi:10.1016/s0002-9149(02)03005-9.

11. Kaitani K, Inoue K, Kobori A, et al. Efficacy of antiarrhythmic drugs short-term use after catheter ablation for atrial fibrillation (EAST-AF) trial. Eur Heart J. 2016;37(7):610-18. doi:10.1093/eurheartj/ehv501.

12. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Russian Journal of Cardiology. 2021;26(9):4701. (In Russ.) doi:10.15829/1560-4071-2021-4701.

13. Bokeriya LA, Bazaev VA, Filatov AG, et al. Electrophysiological study in atrial fibrillation. Annals of Arrhythmology. 2006;6:48-58. (In Russ.) Бокерия Л. А., Базаев В. А., Филатов А. Г. и др. Электрофизиологическое исследование при фибрилляции предсердий. Анналы аритмологии. 2006;6:48-58.

14. Taghji P, El Haddad M, Phlips T, et al. Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins With Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation: A Pilot Study. JACC Clin Electrophysiol. 2018;4(1):99-108. doi:10.1016/j.jacep.2017.06.023.

15. Allessie M, Ausma J, Schotten U. Electrical, contractile and struc­tural remodeling during atrial fibrillation. Cardiovascular research. 2002;54(2):230-46. doi:10.1016/s0008-6363(02)00258-4.

16. Spach MS, Barr RC, Jewett PH. Spread of excitation from the atrium into thoracic veins in human beings and dogs. Am J Cardiol. 1972;30:844-54. doi:10.1016/0002-9149(72)90009-4.

17. Roux JF, Zado E, Callans DJ, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study). Circulation. 2009;120(12):1036-40. doi:10.1161/CIRCULATIONAHA.108.839639.

18. Darkner S, Chen Xu, Hansen J, et al. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation: a double-blind, randomized, placebo-controlled study (AMIO-CAT trial). Eur Heart J. 2014;35(47):3356-64. doi:10.1093/eurheartj/ehu354.

19. Tarasov AV, Davtyan KV, Martsevich SYu. Comparison of effectiveness of antiarrhythmic therapies in postoperative period of pulmonary vein ostia catheter isolation for prevention of early recurrences of atrial tachyarrhythmias in the PROOF study. Rational Phar­macotherapy in Cardiology. 2017;13(1):18-24. (In Russ.) doi:10.20996/1819-6446-2017-13-1-18-24.