Key result
Unlike low-voltage areas, AC score links to ~122% higher cardiovascular risk while both predict AF recurrence.
Why the study?
Voltage mapping requires considerable time and cost, and the optimal prognostic predictor for patients with preserved LVEF after AF ablation remains unclear.
Do left atrial low-voltage areas and the postprocedural atrial cardiomyopathy score predict AF recurrence and cardiovascular events in patients with preserved LVEF after AF ablation?
Cohort (n=270)
Do left atrial low-voltage areas and the postprocedural atrial cardiomyopathy score predict AF recurrence and cardiovascular events in patients with preserved LVEF after AF ablation?
Effect estimate: HR 1.49 (AC score); HR 1.05 (LVA)
p-value: p=<0.001 (AC score); 0.004 (LVA)
The postprocedural atrial cardiomyopathy score is a stronger and more cost-effective predictor of cardiovascular events than low-voltage areas in patients with preserved LVEF after AF ablation.
AC score may enhance post-ablation CV risk stratification beyond LVA; hypothesis-generating in preserved LVEF and requires prospective validation.
BACKGROUND Left atrial low-voltage areas (LVAs) and the postprocedural atrial cardiomyopathy (AC) score-which incorporates echocardiographic data and brain natriuretic peptide levels-are linked to outcomes in patients undergoing catheter ablation of atrial fibrillation (AF).However, voltage mapping requires considerable time and cost, and the optimal prognostic predictor for patients with preserved left ventricular ejection fraction (LVEF) after AF ablation remains unclear.OBJECTIVE This study analyzed the relationship between LVAs, the AC score, and outcomes among patients with preserved LVEF after AF ablation.METHODS We retrospectively analyzed 270 patients with preserved LVEF who underwent AF ablation.Blood tests and transthoracic echocardiography were performed 2 weeks before and 3 months after ablation.We defined LVAs as regions with a bipolar peak-to-peak voltage of ,0.50 mV.Patients were divided into 2 groups: no LVA (LVA size ,5 cm 2 , n 5 207) and LVA (5 cm 2 , n 5 63).RESULTS Multivariate analysis revealed that both the postprocedural AC score and the presence of LVA were independently associated with AF recurrence (hazard ratio [HR] 5 1.49, P , .001;HR 5 1.05, P 5 .004).However, the postprocedural AC score was independently associated with cardiovascular events (HR 5 2.22, P , .001),whereas the presence of LVA was not (HR 5 1.13, P 5 .796).CONCLUSION The presence of LVA and the postprocedural AC score are associated with AF recurrence.However, the AC score is a more cost-effective and stronger predictor of cardiovascular events in patients with preserved LVEF after AF ablation than the presence of LVA.
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Sumiyoshi et al. (2025) conducted a cohort in Atrial fibrillation with preserved LVEF (n=270). Postprocedural atrial cardiomyopathy (AC) score and low-voltage areas (LVAs) vs. No LVA (<5 cm2) vs LVA (≥5 cm2) was evaluated on Atrial fibrillation recurrence (HR 1.49 (AC score); HR 1.05 (LVA), p=<0.001 (AC score); 0.004 (LVA)). Both postprocedural AC score and low-voltage areas predicted AF recurrence, but only the AC score was independently associated with cardiovascular events (HR 2.22, P<0.001).
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