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Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures
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 uncer...
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| Published in: | Journal of cardiovascular electrophysiology 2024-06, Vol.35 (6), p.1156-1164 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Georgi, Christian Bannehr, Marwin Lochmann, Marlene Reiners, David Haase‐Fielitz, Anja Butter, Christian Seifert, Martin |
| description | 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 |
| doi_str_mv | 10.1111/jce.16266 |
| format | article |
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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 <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).
Conclusion
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.
The amount of left atrial low voltage areas (LVA) rather than left atrial volume predicts arrhythmia recurrence in repeat ablation on procedures. A thorough 3‐D mapping and LVA assessment of the left atrium should be accomplished by default to optimize patient selection for further interventions.</description><identifier>ISSN: 1045-3873</identifier><identifier>ISSN: 1540-8167</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.16266</identifier><identifier>PMID: 38566599</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>Journal of cardiovascular electrophysiology, 2024-06, Vol.35 (6), p.1156-1164</ispartof><rights>2024 The Authors. published by Wiley Periodicals LLC.</rights><rights>2024 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3486-8dadd48fcad6ac0772014fc71c07052c5c8e4cfb88472704c7122fad8873f44b3</cites><orcidid>0000-0002-5991-2333</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38566599$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Georgi, Christian</creatorcontrib><creatorcontrib>Bannehr, Marwin</creatorcontrib><creatorcontrib>Lochmann, Marlene</creatorcontrib><creatorcontrib>Reiners, David</creatorcontrib><creatorcontrib>Haase‐Fielitz, Anja</creatorcontrib><creatorcontrib>Butter, Christian</creatorcontrib><creatorcontrib>Seifert, Martin</creatorcontrib><title>Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>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 <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).
Conclusion
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.
The amount of left atrial low voltage areas (LVA) rather than left atrial volume predicts arrhythmia recurrence in repeat ablation on procedures. A thorough 3‐D mapping and LVA assessment of the left atrium should be accomplished by default to optimize patient selection for further interventions.</description><subject>Ablation</subject><subject>Action Potentials</subject><subject>Aged</subject><subject>Arrhythmia</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Atrial Function, Left</subject><subject>Atrial Remodeling</subject><subject>Cardiac arrhythmia</subject><subject>Catheter Ablation - adverse effects</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Atria - surgery</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>left atrial volume</subject><subject>low voltage areas</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>predictors of recurrence</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Registries</subject><subject>Reoperation</subject><subject>repeat ablation</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Tachycardia</subject><subject>Tachycardia, Supraventricular - diagnosis</subject><subject>Tachycardia, Supraventricular - etiology</subject><subject>Tachycardia, Supraventricular - physiopathology</subject><subject>Tachycardia, Supraventricular - surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Voltage</subject><issn>1045-3873</issn><issn>1540-8167</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kc9KJDEQxoO4-P_gC0jAi4KtSSedjkcZ_LcMeNFzk05XNENPZ0zSirCHfQSfcZ9kS2fcg7B1qaLy4_sqfITsc3bKsc5mFk65KpVaI1u8kqzQXNXrODNZFULXYpNspzRjjAvFqg2yKXSlVHV-vkV-TcFlanL0pqd9eP3z-_0l9Nk8AjURTDqh7ZjpEDLF9TiHE7qI0HmbaX4CGsGOMcJggQb3peJ8G33fm-zDQP2A0AIMerSr1SIGC90YIe2SH870CfZWfYc8XF3eT26K6d317eRiWlghtSp0Z7pOamdNp4xldV0yLp2tOc6sKm1lNUjrWq1lXdZM4ktZOtNp_LmTshU75Gipi9bPI6TczH2ygDcOEMbUCCa4UkxpiejhN3QWxjjgdUgpdK5EWSN1vKRsDClFcM0i-rmJbw1nzUckDUbSfEaC7MFKcWzn0P0jvzJA4GwJvPoe3v6v1PycXC4l_wI6L5c5</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Georgi, Christian</creator><creator>Bannehr, Marwin</creator><creator>Lochmann, Marlene</creator><creator>Reiners, David</creator><creator>Haase‐Fielitz, Anja</creator><creator>Butter, Christian</creator><creator>Seifert, Martin</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5991-2333</orcidid></search><sort><creationdate>202406</creationdate><title>Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures</title><author>Georgi, Christian ; Bannehr, Marwin ; Lochmann, Marlene ; Reiners, David ; Haase‐Fielitz, Anja ; Butter, Christian ; Seifert, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3486-8dadd48fcad6ac0772014fc71c07052c5c8e4cfb88472704c7122fad8873f44b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Ablation</topic><topic>Action Potentials</topic><topic>Aged</topic><topic>Arrhythmia</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrial Function, Left</topic><topic>Atrial Remodeling</topic><topic>Cardiac arrhythmia</topic><topic>Catheter Ablation - adverse effects</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Atria - surgery</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>left atrial volume</topic><topic>low voltage areas</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>predictors of recurrence</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Registries</topic><topic>Reoperation</topic><topic>repeat ablation</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Tachycardia</topic><topic>Tachycardia, Supraventricular - diagnosis</topic><topic>Tachycardia, Supraventricular - etiology</topic><topic>Tachycardia, Supraventricular - physiopathology</topic><topic>Tachycardia, Supraventricular - surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Voltage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Georgi, Christian</creatorcontrib><creatorcontrib>Bannehr, Marwin</creatorcontrib><creatorcontrib>Lochmann, Marlene</creatorcontrib><creatorcontrib>Reiners, David</creatorcontrib><creatorcontrib>Haase‐Fielitz, Anja</creatorcontrib><creatorcontrib>Butter, Christian</creatorcontrib><creatorcontrib>Seifert, Martin</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Georgi, Christian</au><au>Bannehr, Marwin</au><au>Lochmann, Marlene</au><au>Reiners, David</au><au>Haase‐Fielitz, Anja</au><au>Butter, Christian</au><au>Seifert, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2024-06</date><risdate>2024</risdate><volume>35</volume><issue>6</issue><spage>1156</spage><epage>1164</epage><pages>1156-1164</pages><issn>1045-3873</issn><issn>1540-8167</issn><eissn>1540-8167</eissn><abstract>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 <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).
Conclusion
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.
The amount of left atrial low voltage areas (LVA) rather than left atrial volume predicts arrhythmia recurrence in repeat ablation on procedures. A thorough 3‐D mapping and LVA assessment of the left atrium should be accomplished by default to optimize patient selection for further interventions.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>38566599</pmid><doi>10.1111/jce.16266</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-5991-2333</orcidid><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Left atrial low‐voltage areas, but not volume, predict the recurrence of atrial fibrillation in repeat ablation procedures |
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