Highlights
- •Non-ischemic ST-segment depression during atrial fibrillation rhythm is common.
- •ST-segment depression related to late arrhythmia recurrence after ablation.
- •Lead locations and types of ST depression did not relate to post-ablation outcome.
Abstract
Background
ST-segment depression suggests the presence of coronary artery disease (CAD) during
sinus rhythm, but the clinical significance, including the outcomes after catheter
ablation (CA), in atrial fibrillation (AF) patients remain unknown.
Methods
The present study included persistent AF (PerAF) patients from the Osaka Rosai Atrial
Fibrillation ablation (ORAF) registry who underwent an initial ablation and had no
history of CAD. We assigned the patients based on the presence of ST-segment depression
before CA and evaluated the impact of relevant factors on ST-segment depression and
the relationship between ST-segment depression, including leads locations (anterior
leads, inferior leads, and lateral leads) or depression type (upsloping, horizontal,
and downsloping) or the degree of ST-segment depression and late recurrence of AF
(LRAF).
Results
This study population included a total of 551 patients of whom 189 had ST-segment
depression. The median follow-up duration was 397 days and LRAF occurred in 195 patients.
By multiple regression analysis, diabetes mellitus, hemoglobin, brain natriuretic
peptide, left ventricular ejection fraction, and left atrial diameter were significant
determinants of ST-segment depression before CA. Kaplan-Meier analysis demonstrated
that the patients with ST-segment depression had a significantly greater risk of LRAF
than those without (p < 0.001). Multivariate Cox proportional hazards analysis showed ST-segment depression
was independently and significantly associated with a higher risk of LRAF (p < 0.001). The patients with ST-segment depression ≥0.15 mV had a significantly higher
risk of LRAF than those with ST-segment depression ≥0.15 mV (p < 0.001). No significant differences among the ST-segment depression lead locations
and ST-segment depression type were observed.
Conclusion
Non-ischemic ST-segment depression during AF rhythm was significantly associated with
LRAF post CA in PerAF patients.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 04, 2023
Accepted:
February 5,
2023
Received in revised form:
January 18,
2023
Received:
November 22,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
