The Impact of Close Proximity of Left Atrium to Descending Aorta on Left Inferior Pulmonary Vein Triggers or Drivers of Atrial Fibrillation: A Risk Score Model

Bautista JAL 1 , Liu CM 2 , Ibrahim AE 1 , Lo LW 3 , Chung FP 2 , Hu YF 2 Show all authors , Chang SL 2 , Lin YJ 2 , Lin CY 2 , Chang TY 2 , Kuo L 2 , Liu SH 2 , Cheng WH 2 , Chen WT 4 , Kao PH 4 , Kuo MJ 5 , Nguyen-Khac TC 4 , Li GY 4 , Lin CH 4 , Huang YS 4 , Wu SJ 6 , Siow YK 7 , Ngoc DSN 8 , Tran DC 9 , Chen SA 10

Affiliations 

  • 1 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Section of Clinical Cardiac Electrophysiology, Heart Institute, St. Luke's Medical Center - Global City, Taguig City, Philippines
  • 2 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
  • 3 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. Electronic address: gyrus@ms65.hinet.net
  • 4 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • 5 Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
  • 6 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
  • 7 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Cardiology, Serdang Hospital, Selangor, Malaysia
  • 8 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; University Medical Center, Ho Chi Minh City, Vietnam
  • 9 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Cho Ray Hospital, Ho Chi Minh City, Vietnam
  • 10 Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan; National Chung Hsing University, Taichung, Taiwan. Electronic address: epsachen@ms41.hinet.net
Heart Rhythm, 2024 Jul 10.
PMID: 38997056 DOI: 10.1016/j.hrthm.2024.06.062

Abstract

BACKGROUND: Prior studies have investigated cardiac anatomy and clinical parameters as predictors for pulmonary vein and non-pulmonary vein triggers.

OBJECTIVES: To assess the link between the descending aorta to left inferior pulmonary vein (Dao-LIPV) distance and the occurrence of triggers and drivers in atrial fibrillation (AF) ablation procedures.

METHODS: Drug-refractory AF patients who underwent first-time index catheter ablation from January 2010 to December 2019 were retrospectively assembled. The Dao-LIPV distance was measured from pre-ablation pulmonary vein computed tomography. Patients were categorized based on the presence of LIPV triggers and/or drivers. Multivariate logistic regression was used to identify risk factors.

RESULTS: A total of 886 consecutive patients with drug-refractory AF were studied, and 63 (7.1%) patients were identified to have LIPV triggers and/or drivers. The Dao-LIPV distance had a better predictive performance (AUC: 0.70) compared to persistent AF (AUC: 0.57). Multivariate logistic regression analysis showed that Dao-LIPV distance ≤ 2.5 mm (Odds ratio [OR] 3.96 [95% CI 2.15-7.29], p <0.001) and persistent AF (OR 1.73 [95% CI 1.02-2.94], p=0.044) were independent predictors for the presence of LIPV triggers and/or drivers. A risk score model was established to predict the probability of LIPV triggers or drivers with persistent AF (10.2%), Dao-LIPV distance ≤ 2.5mm (11.4%), and both (15.0%).

CONCLUSIONS: The close proximity of the Dao-LIPV was correlated to the presence of LIPV triggers or drivers. We developed a risk score model indicating that persistent AF and Dao-LIPV distances ≤ 2.5mm significantly increase the risk of LIPV triggers/drivers, aiding electrophysiologists in preparing for and performing catheter ablation more effectively.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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