Left atrial low-voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures.
atrial fibrillation
left atrial volume
low voltage areas
predictors of recurrence
repeat ablation
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
03 Apr 2024
03 Apr 2024
Historique:
revised:
11
03
2024
received:
20
10
2023
accepted:
18
03
2024
medline:
3
4
2024
pubmed:
3
4
2024
entrez:
3
4
2024
Statut:
aheadofprint
Résumé
Left atrial (LA) low voltage areas (LVA) are a controversial target in atrial fibrillation ablation procedures. However, LVA and LA volume are good predictors of arrhythmia recurrence in ablation-naïve patients. Their predictive value in progressively diseased pre-ablated atria is uncertain. Consecutive patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT), who were scheduled for repeat LA ablation, were enrolled in the prospective Bernau ablation registry between 2016 and 2020. All patients received a complete LA ultrahigh-density map before ablation. Maps were analyzed for LA size, LVA percentage and distribution. The predictive value of demographic, anatomic, and mapping variables on AF recurrence was analyzed. 160 patients (50.6% male, 1.3 pre-ablations, 60% persistent AF) with complete LA voltage maps were included. Mean follow-up time was 16 ± 11 months. Mean recorded electrograms (EGMs) per map were 9754 ± 5808, mean LA volume was 176.1 ± 35.9 ml and mean rate of LVAs <0.5 mV was 30.6% ± 23.1%. During follow-up recurrence rate of AF or AT >30 s was 55.6%. Patients with recurrence had a significant higher percentage of LVAs (40.0% vs. 18.8%, p < .001) but no relevant difference in LA volume (172 vs. 178 mL, p = .299). ROC curves revealed LVA as a good predictor for recurrence (AUC = 0.79, p < .001) and a cut-off of 22% LVAs with highest sensitivity (73.0%) and specificity (71.8%). Based on this cut off, event free survival was significantly higher in the Low LVA group (p < .01). Total LVA percentage has a good predictive power on arrhythmia recurrence in a cohort of advanced scarred left atria in repeat procedures independent of the applied ablation strategy. Left atrial volume seems to have minor impact on the rhythm outcome in our study cohort.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
Références
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42:373‐498. doi:10.1093/eurheartj/ehaa612
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. EP Europace. 2018;20:157‐208. doi:10.1093/europace/eux275.
Verma A, Jiang C, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372:1812‐1822. doi:10.1056/NEJMoa1408288
Goette A, Kalman JM, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterisation, and clinical implication. J Arrhythm. 2016;32:247‐278. doi:10.1016/j.joa.2016.05.002
Schnabel RB, Marinelli EA, Arbelo E, et al. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference. EP Europace. 2023;25:6‐27. doi:10.1093/europace/euac062
Huo Y, Gaspar T, Schönbauer R, et al. Low‐voltage myocardium‐guided ablation trial of persistent atrial fibrillation. NEJM Evidence. 2022;1:EVIDoa2200141. doi:10.1056/EVIDoa2200141
Marrouche NF, Wazni O, McGann C, et al. Effect of MRI‐guided fibrosis ablation vs conventional catheter ablation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the DECAAF II randomized clinical trial. JAMA. 2022;327:2296‐2305. doi:10.1001/jama.2022.8831
Masuda M, Fujita M, Iida O, et al. Left atrial low‐voltage areas predict atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. Int J Cardiol. 2018;257:97‐101. doi:10.1016/j.ijcard.2017.12.089
Vlachos K, Efremidis M, Letsas KP, et al. Low‐voltage areas detected by high‐density electroanatomical mapping predict recurrence after ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2017;28:1393‐1402. doi:10.1111/jce.13321
Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta‐analysis. EP Europace. 2018;20:33‐42. doi:10.1093/europace/eux013
Strisciuglio T, Di Gioia G, Chatzikyriakou S, et al. Left atrial volume computed by 3D rotational angiography best predicts atrial fibrillation recurrence after circumferential pulmonary vein isolation. Int J Cardiovasc Imaging. 2018;34:337‐342. doi:10.1007/s10554-017-1243-7
Daoud EG, Weiss R, Augostini R, et al. Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:157‐165. doi:10.1111/j.1540-8167.2006.00312.x
Winkle RA, Mead RH, Engel G, et al. Very long term outcomes of atrial fibrillation ablation. Heart Rhythm. 2023;20:680‐688. doi:10.1016/j.hrthm.2023.02.002
Bijvoet GP, Nies HMJM, Holtackers RJ, et al. Correlation between cardiac MRI and voltage mapping in evaluating atrial fibrosis: a systematic review. Radiol: Cardiothorac Imaging. 2022;4:e220061. doi:10.1148/ryct.220061
Rossi VA, Krizanovic‐Grgic I, Steffel J, et al. Predictors of left atrial fibrosis in patients with atrial fibrillation referred for catheter ablation. Cardiol J. 2022;29:413‐422. doi:10.5603/CJ.a2022.0012
Huo Y, Gaspar T, Pohl M, et al. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation. EP Europace. 2018;20:956‐962. doi:10.1093/europace/eux082
Yamaguchi T, Otsubo T, Takahashi Y, et al. Atrial structural remodeling in patients with atrial fibrillation is a diffuse fibrotic process: evidence from high‐density voltage mapping and atrial biopsy. J Am Heart Assoc. 2022;11:e024521. doi:10.1161/JAHA.121.024521
Benali K, Barré V, Hermida A, et al. Recurrences of atrial fibrillation despite durable pulmonary vein isolation: the PARTY‐PVI study. Circ Arrhythm Electrophysiol. 2023;16:e011354. doi:10.1161/circep.122.011354
Kurata N, Masuda M, Kanda T, et al. Left atrial localized low‐voltage areas indicate whole left atrial electrophysiological degeneration in atrial fibrillation patients. Circ J. 2022;86:192‐199. doi:10.1253/circj.CJ-21-0527
Sugumar H, Nanayakkara S, Chieng D, et al. Arrhythmia recurrence is more common in females undergoing multiple catheter ablation procedures for persistent atrial fibrillation: time to close the gender gap. Heart Rhythm. 2020;17:692‐698. doi:10.1016/j.hrthm.2019.12.013
Ravelli F, Masè M, Cristoforetti A, et al. Quantitative assessment of transmural fibrosis profile in the human atrium: evidence for a three‐dimensional arrhythmic substrate by slice‐to‐slice histology. EP Europace. 2023;25:739‐747. doi:10.1093/europace/euac187
Moustafa A, Karim S, Kahaly O, et al. Low voltage area guided substrate modification in nonparoxysmal atrial fibrillation: a systematic review and meta‐analysis. J Cardiovasc Electrophysiol. 2023;34:455‐464. doi:10.1111/jce.15764
Yang G, Zheng L, Jiang C, et al. Circumferential pulmonary vein isolation plus low‐voltage area modification in persistent atrial fibrillation. JACC Clin Electrophysiol. 2022;8:882‐891. doi:10.1016/j.jacep.2022.03.012
Starek Z, Di Cori A, Betts TR, et al. Baseline left atrial low‐voltage area predicts recurrence after pulmonary vein isolation: WAVE‐MAP AF results. Europace. 2023;25(9):euad194. doi:10.1093/europace/euad194