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

Figures

• 

  Fig. 1. Of the 162 patients, 152 patients with sinus rhythm before mapping were included. Depending on the presence or absence of AT induction, they were classified as groups N, F, and M. Group N was divided into two groups based on the recurrence of AT and analyzed. N, non-induced atrial tachycardia; F, focal atrial tachycardia; M, macroreentrant atrial tachycardia; LVA, low-voltage area; SR, sinus rhythm; PVI, pulmonary vein isolation; ISP, isoproterenol; ATP, adenosine triphosphate, CTI ablation, cavo- tricuspid isthmus ablation; AT, atrial tachycardia

• 

  Fig. 2. A AT was induced more in the right atrium in the focal type and in the left atrium in the macroreentrant type. B Burst pacing induced mostly left atrial reentrant tachycardia, and ISP stress was the only focal type. AT, atrial tachycardia; F, focal atrial tachycardia; M, macroreentrant atrial tachycardia; rRAT, reentrant right atrial tachycardia; fRAT, focal right atrial tachycardia; rLAT, reentrant left atrial tachycardia; fLAT, focal left atrial tachycardia; Burst, burst pacing; ISP, isoproterenol

• 

  Fig. 3. A The M group had significantly more LVA than the N/F groups (P < 0.001). B In the ROC curve, the macroreentrant AT-induced cut-off value was 8.8 cm2; specificity, 0.90; sensitivity, 0.81; AUC, 0.86 (95%CI: 0.75–0.97). LVA, low-voltage area; N, non-induced atrial tachycardia; F, focal atrial tachycardia; M, macroreentrant atrial tachycardia; ROC, receiver operating characteristic; AUC, area under the curve; CI, confidence interval

• 

  Fig. 4. The treatment strategy and number of cases for group M are shown on the left side. One case is shown on the right side

• 

  Fig. 5. A The group with recurrent AT had significantly more LVA at the first ablation than the group without recurrent AT (P < 0.001). B In the ROC curve, the cut-off value of the LVA area at first ablation when macroreentrant AT recurred was 6.5 cm2, with a specificity of 1.00 and a sensitivity of 0.90, AUC 0.94 (95%CI: 0.88–0.99). LVA, low-voltage areas; AT( −), no recurrence due to atrial tachycardia, AT( +), recurrence due to atrial tachycardia; ROC, receiver operating characteristic; AUC, area under the curve; CI, confidence interval