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Invers-Rubio E, Hernández-Romero I, Reventos-Presmanes J, Ferro E, Guichard JB, Regany-Closa M, Pellicer-Sendra B, Borras R, Prat-Gonzalez S, Tolosana JM, Porta-Sanchez A, Arbelo E, Guasch E, Sitges M, Brugada J, Guillem MS, Roca-Luque I, Climent AM, Mont L, Althoff TF. Regional conduction velocities determined by non-invasive mapping are associated with arrhythmia-free survival after atrial fibrillation ablation. Heart Rhythm 2024:S1547-5271(24)02390-7. [PMID: 38636930 DOI: 10.1016/j.hrthm.2024.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/24/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Atrial arrhythmogenic substrate is a key determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI), and reduced conduction-velocities have been linked to adverse outcome. However, a non-invasive method to assess such electrophysiological substrate is not available to date. OBJECTIVE This study aimed to non-invasively assess regional conduction-velocities and their association with arrhythmia-free survival following PVI. METHODS 52 consecutive patients scheduled for AF ablation (PVI-only) and 19 healthy controls were prospectively included and received electrocardiographic imaging (ECGi) to non-invasively determine regional atrial conduction-velocities in sinus rhythm. A novel ECGi technology obviating the need of additional CT- or CMR-imaging was applied and validated using invasive mapping. RESULTS Mean ECGi-determined atrial conduction-velocities were significantly lower in AF-patients than in healthy controls (1.45±0.15 versus 1.64±0.15m/s; p<0.0001). Differences were particularly pronounced in a regional analysis considering only the segment with the lowest average conduction-velocity in each patient (0.8±0.22 versus 1.08±0.26m/s; p<0.0001). This average conduction velocity of the "slowest" segment was independently associated with arrhythmia recurrence and better discriminated between PVI-responders and non-responders than previously proposed predictors including left atrial size or late-gadolinium-enhancement (MRI). Patients without slow-conduction areas (mean conduction-velocity <0.78m/s) showed significantly higher 12-months arrhythmia-free survival than those with one or more slow-conduction areas (88.9% versus 48.0%, p=0.002). CONCLUSIONS This is the first study to investigate regional atrial conduction velocities non-invasively. The absence of ECGi-determined slow-conduction areas well discriminates PVI-responders from non-responders. Such non-invasive assessment of electrical arrhythmogenic substrate may guide treatment strategies and be a step towards personalised AF therapy.
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Affiliation(s)
- Eric Invers-Rubio
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Ismael Hernández-Romero
- ITACA Institute, Universitat Politècnica de València, Camí de Vera, s/n, 46022 València, Spain
| | - Jana Reventos-Presmanes
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; ITACA Institute, Universitat Politècnica de València, Camí de Vera, s/n, 46022 València, Spain
| | - Elisenda Ferro
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Jean-Baptiste Guichard
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Department of Cardiology, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Mariona Regany-Closa
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Berta Pellicer-Sendra
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Roger Borras
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain
| | - Susanna Prat-Gonzalez
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain
| | - Jose Maria Tolosana
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andreu Porta-Sanchez
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Eduard Guasch
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Marta Sitges
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Josep Brugada
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Maria S Guillem
- ITACA Institute, Universitat Politècnica de València, Camí de Vera, s/n, 46022 València, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Andreu M Climent
- ITACA Institute, Universitat Politècnica de València, Camí de Vera, s/n, 46022 València, Spain
| | - Lluís Mont
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain.
| | - Till F Althoff
- Department of Cardiology, Hospital Clínic Cardiovascular Institute (ICCV), Universitat de Barcelona, C/Villarroel N° 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ del Rosselló, 149, 08036 Barcelona, Catalonia, Spain.
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