Ilana Kutinsky, MD; Steven Castellano, PhD; Nishaki Mehta, MD; Brian Williamson, MD; David Haines, MD; Melissa H. Kong, MD
ABSTRACT
Background
Electrographic Flow (EGF) mapping allows for the near real-time visualization of atrial wavefront propagation. Two factors have been found to be associated with higher rates of AF recurrence: presence of active extra-pulmonary vein (PV) sources and low electrographic flow consistency (EGFC) representing chaotic flow and abnormal atrial substrate. Based on these characteristics, EGF phenotypes have been identified: Type I patients have no sources + high EGFC; Type II have sources + high EGFC; Type III have sources + low EGFC; Type IV have no sources + low EGFC.
Objective
Determine the sex differences in EGF phenotypes of AF and 1-year post-ablation outcomes.
Methods
Prospectively, 102 persistent or long-standing persistent AF (PeAF) patients underwent EGF mapping with 5 standardized, biatrial basket positions recorded both pre- and post-PVI. Phenotyping was performed from post-PVI maps. Patients were followed for 12 months post-randomization.
Results
There were 29 (28%) female patients, mean age 70±8 years and mean LA size 4.3±0.5cm and 73 (72%) males, mean age 64±10 years and mean LA size 4.6±0.6cm. There was no difference in AF duration, history of atrial flutter, # of prior ablations, CHF, hypertension, diabetes, vascular disease. Male and female patients had distinct phenotype distributions (p<0.001). Females were more likely to have active extra-PV sources (72% v. 58%, p=0.011) and high EGFC (48% v. 35% with normal substrate, p=0.016) than males, and age was unrelated to source presence or EGFC (p>0.5). Females were over twice as likely to present as Type II (45% v. 21%, p<0.001). For the overall population, Type I patients had 0% recurrence and Type IV patients had 50% recurrence, while ablated Type II had 12% v. 50% unablated, and ablated Type III had 54% v. 73% unablated.
Conclusions
Female patients with PeAF present for ablation at an older age and are more likely to have extra-PV sources but normal underlying substrate (Type II), which responds best to PVI + targeted source ablation.
Figure
A) Phenotype distribution by sex; B) Recurrence percent of treated patients.
