Large Volume and High Dominant Frequency of Left Atrial Appendage Is Associated with a Refractory to Pulmonary Vein Isolation

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Background: Although dominant frequency (DF) sites are considered as drivers in maintaining atrial fibrillation, the association between DF and the left atrial appendage volume is unknown. Methods: BARD Lab system were used to map the left atrium (LA), left atrial appendage (LAA), 4 pulmonary veins (PVs) in 15 AF patients (non-paroxysmal=7) DF by a fast frontier transform analysis was analyzed and compared to the pre-acquired CT volume of each segment. Result: Nine patients, who did not respond to PV isolation (PVI), had a larger volume and higher DF in the LAA than 6 patients in whom AF was terminated by PVI (LAA-volume 16.7±5.0 mm3 versus 10.4±3.3 mm3, p<0.05, LA-DF 6.7±1.2 versus 5.5±1.3 Hz, p=0.10). There was a correlation between the LA volume and DF, but no correlation was observed in the PVs. In 4 of 9 PVI non responders, CFEA-based ablation around the LAA terminated the AF. Conclusions: Larger LAA volume tended to be resistant to PVI. Additional ablation to the LAA orifice with a high DF may be a therapeutic option for the PVI non-responders.