Structural Remodeling and Rotational Activity in Persistent/Long-Lasting Atrial Fibrillation : Gender-Effect Differences and Impact on Post-ablation Outcome
Ríos-Muñoz, Gonzalo R. (Universidad Carlos III de Madrid. Departamento de Bioingeniería e Ingeniería Aeroespacial)
Soto, Nina (Universitat Autònoma de Barcelona. Departament de Medicina)
Ávila, Pablo (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Carta, Alejandro (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Atienza, Felipe (Universidad Complutense de Madrid)
Datino, Tomás (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
González-Torrecilla, Esteban (Universidad Complutense de Madrid)
Fernández Avilés, F. (Universidad Complutense de Madrid)
Arenal Maiz, Ángel (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)

Fecha:	2022
Resumen:	Structural and post-ablation gender differences are reported in atrial fibrillation (AF). We analyzed the gender differences in structural remodeling and AF mechanisms in patients with persistent/long-lasting AF who underwent wide area circumferential pulmonary vein isolation (WACPVI). Ultra-high-density mapping was used to study atrial remodeling and AF drivers in 85 consecutive patients. Focal and rotational activity (RAc) were identified with the CartoFinder system and activation sequence analysis. The impact of RAc location on post-ablation outcomes was analyzed. This study included 64 men and 21 women. RAc was detected in 73. 4% of men and 38. 1% of women (p = 0. 003). RAc patients had higher left atrium (LA) voltage (0. 64 ± 0. 3 vs. 0. 50 ± 0. 2 mV; p = 0. 01), RAc sites had higher voltage than non-RAc sites 0. 77 ± 0. 46 vs. 0. 53 ± 0. 37 mV (p < 0. 001). Women had lower LA voltage than men (0. 42 vs. 0. 64 mV; p < 0. 001), including pulmonary vein (PV) antra (0. 16 vs. 0. 30 mV; p < 0. 001) and posterior wall (0. 34 vs. 0. 51 mV; p < 0. 001). RAc in the posterior atrium was recorded in few women (23. 8 vs. 54. 7% in men; p = 0. 014). AF recurrence rate was higher in patients with RAc outside WACPVI than those with all RAc inside WACPVI or no RAc (63. 4 vs. 11. 1 and 31. 0%; p = 0. 008 and p = 0. 01). Comparison of selected patients using propensity score matching confirmed lower atrial voltage (0. 4 ± 0. 2 vs. 0. 7 ± 0. 3 mV; p = 0. 007) and less RAc (38 vs. 75%; p = 0. 02) in women. Women have shown more advanced structural remodeling at ablation, which is associated with a lower incidence of RAc (usually located outside the WACPVI). These findings could explain post-ablation gender differences.
Ayudas:	Instituto de Salud Carlos III DTS21/00064 Ministerio de Economía y Competitividad RD16/0011/0029 Instituto de Salud Carlos III RD21/0017/0002
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Atrial fibrillation ; Gender ; Rotational activity ; Ultra-high density mapping ; AF ablation
Publicado en:	Frontiers in Cardiovascular Medicine, Vol. 9 (march 2022) , ISSN 2297-055X

DOI: 10.3389/fcvm.2022.819429
PMID: 35387439

13 p, 4.6 MB

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