Non-pulmonary vein mediated atrial fibrillation: A novel sub-phenotype

• Published in: PloS one Vol. 12; no. 9; p. e0184354
• Main Authors: Farrell, Maureen, Yoneda, Zachary, Montgomery, Jay, Crawford, Diane, Wray, Lauren Lee, Xu, Meng, Kolek, Matthew J., Richardson, Travis, Lugo, Ricardo, Metawee, Mohamed, Michaud, Greg, Estrada, Juan Carlos, Saavedra, Pablo, Shen, Sharon, Kanagasundram, Arvindh, Ellis, Christopher R., Crossley, George, Roden, Dan, Shoemaker, M. Benjamin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.09.2017; Public Library of Science (PLoS)
• Subjects: Ablation; Aged; Arrhythmia; Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrium; Biology and Life Sciences; Cardiac arrhythmia; Care and treatment; Catheter Ablation; Catheters; Development and progression; Diabetes; Fibrillation; Heart; Humans; Informatics; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Multivariate Analysis; Patients; Physical Sciences; Precision medicine; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Regression Analysis; Research and Analysis Methods; Studies; Task forces; Veins & arteries; United States > US; Tennessee; Nashville Tennessee
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0184354

Atrial fibrillation (AF) is a mechanistically heterogeneous disorder, and the ability to identify sub-phenotypes ("endophenotypes") of AF would assist in the delivery of personalized medicine. We used the clinical response to pulmonary vein isolation (PVI) to identify a sub-group of patients with non-PV mediated AF and sought to define the clinical associations. Subjects enrolled in the Vanderbilt AF Ablation Registry who underwent a repeat AF ablation due to arrhythmia recurrence were analyzed on the basis of PV reconnection. Subjects who had no PV reconnection were defined as "non-PV mediated AF". A comparison group of subjects were identified who had AF that was treated with PVI-only and experienced no arrhythmia recurrence >12 months. They were considered a group enriched for "PV-mediated AF". Univariate and multivariable binary logistic regression analysis was performed to investigate clinical associations between the PV and non-PV mediated AF groups. Two hundred and twenty nine subjects underwent repeat AF ablation and thirty three (14%) had no PV reconnection. They were compared with 91 subjects identified as having PV-mediated AF. Subjects with non-PV mediated AF were older (64 years [IQR 60,71] vs. 60 [52,67], P = 0.01), more likely to have non-paroxysmal AF (82% [N = 27] vs. 35% [N = 32], P<0.001), and had a larger left atrium (LA) (4.2cm [3.6,4.8] vs. 4.0 [3.3,4.4], P = 0.04). In univariate analysis, age (per decade: OR 1.56 [95% CI: 1.04 to 2.33], P = 0.03), LA size (per cm: OR 1.8 [1.06 to 3.21], P = 0.03) and non-paroxysmal AF (OR 8.3 [3.10 to 22.19], P<0.001) were all significantly associated with non-PV mediated AF. However, in multivariable analysis only non-paroxysmal AF was independently associated with non-PV mediated AF (OR 7.47 [95% CI 2.62 to 21.29], P<0.001), when adjusted for age (per decade: OR 1.25 [0.81 to 1.94], P = 0.31), male gender (OR 0.48 [0.18 to 1.28], P = 0.14), and LA size (per 1cm: 1.24 [0.65 to 2.33], P = 0.52). Non-paroxysmal AF was the only clinical variable found to be independently associated with non-PV mediated AF. We demonstrated that analysis of AF ablation outcomes data can serve as a tool to successfully identify a sub-phenotype of subjects who have non-PV mediated AF. ClinicalTrials.gov ID # NCT02404415.