Association between left atrial low-voltage area and induction and recurrence of macroreentrant atrial tachycardia in pulmonary vein isolation for atrial fibrillation

• Published in: Journal of interventional cardiac electrophysiology 2024-08, Vol.67 (5), p.1199-1210
• Main Authors: Sonoda, Koichiro, Fukushima, Tadatomo, Takei, Asumi, Otsuka, Kaishi, Hata, Shiro, Shinboku, Hiroki, Muroya, Takahiro, Maemura, Koji
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiology; Catheter Ablation - methods; Electric potential; Female; Fibrillation; Heart Atria - physiopathology; Heart Atria - surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Pulmonary Veins - surgery; Recurrence; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular - surgery; Treatment Outcome; Veins; Voltage
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-024-01760-8

Background The relationship between induction and recurrence due to atrial tachycardia (AT) and left atrial (LA) matrix progression after atrial fibrillation (AF) ablation remains unclear. Methods One hundred fifty-two consecutive patients with paroxysmal and persistent AF who underwent pulmonary vein isolation (PVI) and cavo-tricuspid isthmus (CTI) ablation and achieved sinus rhythm before the procedure were classified into three groups according to the AT pattern induced after the procedure: group N (non-induced), F (focal pattern), and M (macroreentrant pattern) in 3D mapping. Results The total rate of AT induction was 19.7% (30/152) in groups F ( n  = 13) and M ( n  = 17). Patients in group M were older than those in groups N and F, with higher CHADS 2 /CHA 2 DS 2 -VASc values, left atrial enlargement, and low-voltage area (LVA) size of LA. The receiver operating characteristic curve determined that the cut-off LVA for macroreentrant AT induction was 8.8 cm 2 (area under the curve [AUC]: 0.86, 95% confidence interval [CI]: 0.75–0.97). The recurrence of AT at 36 months in group N was 4.1% (5/122), and at the second ablation, all patients had macroreentrant AT. Patients with AT recurrence in group N had a wide LVA at the first ablation, and the cut-off LVA for AT recurrence was 6.5 cm 2 (AUC 0.94, 95%CI 0.88–0.99). Adjusted multivariate analysis showed that only LVA size was associated with the recurrence of macroreentrant AT (odds ratio 1.21, 95%CI 1.04–1.51). Conclusions It is important to develop a therapeutic strategy based on the LVA size to suppress the recurrence of AT in these patients. Graphical abstract