Efficacy of electrical isolation of the left atrial posterior wall depends on the existence of left atrial low-voltage zone in patients with persistent atrial fibrillation

Background Modification of the low-voltage zone in the left atrium (LA-LVZ) in addition to pulmonary vein isolation (PVI) has not shown sufficient improvement in arrhythmia-free survival in patients with persistent atrial fibrillation (PerAF). Further, the effect of electrical posterior wall isolati...

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Published in:Heart and vessels 2022-10, Vol.37 (10), p.1757-1768
Main Authors: Uetake, Shunsuke, Maruyama, Mitsunori, Kobayashi, Noriyuki, Arai, Toshiki, Miyauchi, Yasushi
Format: Article
Language:English
Subjects:
Ablation
Arrhythmia
Atria
Biomedical Engineering and Bioengineering
Cardiac arrhythmia
Cardiac Surgery
Cardiology
Electric potential
Fibrillation
Medical instruments
Medicine
Medicine & Public Health
Original Article
Tachyarrhythmia
Tachycardia
Vascular Surgery
Voltage
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Summary:Background Modification of the low-voltage zone in the left atrium (LA-LVZ) in addition to pulmonary vein isolation (PVI) has not shown sufficient improvement in arrhythmia-free survival in patients with persistent atrial fibrillation (PerAF). Further, the effect of electrical posterior wall isolation (PWI) is controversial. We investigated the impact of existence of LA-LVZ on the outcome of patients undergoing additional PWI for PerAF. Methods A total of 347 patients with PerAF who underwent primary catheter ablation with LA-LVZ based strategy were retrospectively analyzed. Voltage mapping in the left atrium (LA) was performed during sinus rhythm. Additional LVZ ablation was performed in patients with LA-LVZ. The operators decided whether additional PWIs were to be performed. Results Of 347 patients, 108 had LA-LVZ. In the LVZ group, patients with additional PWI ( N  = 70) had higher rates of freedom from tachyarrhythmia recurrence than those without (77.1% vs. 42.1%, p  
ISSN:0910-8327
1615-2573
DOI:10.1007/s00380-022-02069-0