Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures

• Published in: Journal of cardiovascular electrophysiology 2024-06, Vol.35 (6), p.1156-1164
• Main Authors: Georgi, Christian, Bannehr, Marwin, Lochmann, Marlene, Reiners, David, Haase‐Fielitz, Anja, Butter, Christian, Seifert, Martin
• Format: Article
• Language: English
• Subjects: Ablation; Action Potentials; Aged; Arrhythmia; atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial Function, Left; Atrial Remodeling; Cardiac arrhythmia; Catheter Ablation - adverse effects; Electrophysiologic Techniques, Cardiac; Female; Fibrillation; Heart Atria - physiopathology; Heart Atria - surgery; Heart Rate; Humans; left atrial volume; low voltage areas; Male; Middle Aged; Predictive Value of Tests; predictors of recurrence; Prospective Studies; Recurrence; Registries; Reoperation; repeat ablation; Risk Assessment; Risk Factors; Tachycardia; Tachycardia, Supraventricular - diagnosis; Tachycardia, Supraventricular - etiology; Tachycardia, Supraventricular - physiopathology; Tachycardia, Supraventricular - surgery; Time Factors; Treatment Outcome; Voltage
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16266

Introduction 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. Methods 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. Results 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 30 s was 55.6%. Patients with recurrence had a significant higher percentage of LVAs (40.0% vs. 18.8%, p