Key result
Left atrial posterior wall unipolar low-voltage areas >2.0 cm2 predict ~590% higher AF recurrence post-PVI.
Why the study?
Beyond PVI, additional therapeutic strategies for AF have not been established, and left atrial remodeling could impact AF recurrence post-PVI.
Does the unipolar voltage criteria of the left atrial posterior wall predict atrial fibrillation recurrence after pulmonary vein isolation in patients with AF?
Observational (n=106)
Does the unipolar voltage criteria of the left atrial posterior wall predict atrial fibrillation recurrence after pulmonary vein isolation in patients with AF?
Effect estimate: HR 6.9 (95% CI 1.3-35.5)
p-value: p=0.021
Lower unipolar voltage in the left atrial posterior wall, indicating electrical remodeling, is associated with a significantly higher risk of AF recurrence after pulmonary vein isolation.
Introduction Beyond pulmonary vein isolation (PVI), additional therapeutic strategies for atrial fibrillation (AF) have not been established. Remodeling of the left atrium (LA) could impact AF recurrence post‐PVI. We investigated the impact of unipolar voltage (UV) criteria for the LA posterior wall (LA‐PW) on AF recurrence post‐PVI. Methods We reviewed the cases of 106 AF patients (mean age 63.8 years, nonparoxysmal AF: 59%) who underwent extensive encircling PVI by radiofrequency ablation guided by a 3‐dimension mapping system, investigating the impact on AF recurrence of the UV criteria of the LA. Results Out of all patients, 26 patients had AF recurrence during post‐PVI follow‐up [median 603 days]. They showed a higher percentage of nonparoxysmal AF (80.8 vs. 52.5%, p = .011), longer AF duration (2.9 ± 2.7 vs. 1.0 ± 1.7 years, p = .002), and larger area size of UV < 2.0 mV in LA‐PW (2.8 ± 1.8 vs. 1.0 ± 1.5 cm 2 , p < .001) than those without recurrence. Cox Hazard analysis for AF recurrence adjusted by age, gender, AF duration, body mass index and left atrial volume index revealed that an area size over 2.0 cm 2 of UV < 2.0 mV in LA‐PW (HR 6.9 [95% CI:1.3–35.5], p = .021) posed independent risks for AF recurrence post‐PVI. The atrial arrhythmia‐free survival rate was higher in those with no area of UV < 3.0 mV in LA‐PW compared to those with a sizable area (>2.0 cm 2 ) of UV < 3.0 mV and <2.0 mV (95.0% vs. 74.2% vs. 57.1%, Log‐Rank: p < .001). In the AF etiology of patients with AF recurrence, 9 of 14 patients who underwent the 2nd procedure had no PV reconnection, and 8 patients required the LA‐PW isolation for their non‐PV AF. Conclusion UV criteria of LA‐PW is a useful parameter for AF‐recurrence post‐PVI. Lower UV in LA‐PW as an indication of electrical remodeling could indicate a higher risk of AF recurrence and the need for further therapeutic strategies.
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Watanabe et al. (2023) conducted an observational in Atrial fibrillation (n=106). Area size over 2.0 cm2 of unipolar voltage < 2.0 mV in the left atrial posterior wall vs. Smaller or no area of unipolar voltage < 2.0 mV was evaluated on Atrial fibrillation recurrence post-pulmonary vein isolation (HR 6.9, 95% CI 1.3-35.5, p=0.021). An area size over 2.0 cm2 of unipolar voltage < 2.0 mV in the left atrial posterior wall independently predicted atrial fibrillation recurrence post-pulmonary vein isolation (HR 6.9; 95% CI 1.3-35.5; p=0.021).
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