P4828Clinical impact of response of intracardiac direct current cardioversion just before pulmonary vein isolation in persistent atrial fibrillation patients

Background: Left atrial remodeling changes, in particular activation of automaticity and substrate changes, produce focal ectopic firing and maintain fibrillation. Persistence of atrial fibrillation (AF) progresses left atrial remodeling and we occasionally experience relapses of AF after cardioversion in persistent AF (PerAF) patients. It is unclear whether response of intracardiac direct current cardioversion (IDC) before pulmonary vein isolation (PVI) is related to late recurrence or not. Methods: We enrolled 88 PerAF patients who underwent IDC just before PVI from April 2014 to February 2017. Average follow-up period was 1 year. IDC was performed by biphasic energy (15J) using duo-decapolar catheter placed right atrium and coronary sinus. We divided into S group who achieved success of sinus conversion by primary IDC and maintained sinus rhythm during procedure and F group who failed sinus conversion by primary IDC or relapse of AF/atrial tachycardia (AT) during procedure. We compared the incidence of late recurrence AF/AT (3 months after PVI) and clinical characteristics between the 2 groups. In addittion, we examined the same above-mentioned parameters to find for the predictors for late recurrence using uni/multivariate analyses.