The impact of left atrial voltage abnormality on ablation outcomes in paroxysmal atrial fibrillation and its pre-procedural predictors: an observational retrospective study

Background Left atrial (LA) localized voltage abnormality displayed by electro-anatomic mapping (EAM) has been established as a surrogate marker of atrial fibrosis (AF) which predicts post-ablation recurrence. This study investigates preoperative predictors of LA voltage abnormalities and assesses their impact on atrial fibrillation recurrence following catheter ablation in patients with paroxysmal atrial fibrillation (PAF). Results Forty-four (25.6%) patients had LA voltage abnormality which independently predicted post-ablation recurrence (HR 2.85, 95%CI 1.20–6.78, p = 0.02). Larger left atrial diameter (LAD) (OR 1.24 per 1 mm, 95%CI 1.02–1.50, p = 0.03) and higher atrial tachyarrhythmia (ATA) burden (OR 1.02 per 1%, 95%CI 1.00–1.04, p = 0.03) independently correlates with LA voltage abnormality with an ideal combined diagnostic efficiency (AUC 0.80, sensitivity 79.3%, specificity 70.7%, 95% CI 0.70–0.89, p < 0.01). Conclusions LA substrate abnormality, even moderate, is an independent risk factor for PAF post-ablation recurrence which can be predicted pre-procedure by LAD and ATA burden.