Key result
Left atrial low-voltage area was independently associated with silent cerebral ischaemia (HR per 1% LVA 1.13; 95% CI 1.06-1.22; P=0.0003) and history of stroke (HR 1.36; 95% CI 1.19-1.60; P<0.0001).
Why the study?
Is left atrial low-voltage area associated with a history of stroke and silent cerebral ischaemia in patients with atrial fibrillation?
Observational (n=200)
Is left atrial low-voltage area associated with a history of stroke and silent cerebral ischaemia in patients with atrial fibrillation?
Hazard Ratio: 1.13 (95% CI 1.06–1.22)
p-value: p=0.0003
Left atrial low-voltage area is independently associated with a history of stroke and silent cerebral ischaemia in patients with non-valvular AF, suggesting it may improve thromboembolic risk stratification beyond the CHA2DS2-VASc score.
May refine AF thromboembolic risk assessment; leaves open incremental value over CHA2DS2-VASc in prospective studies.
Aims: Atrial fibrillation (AF) is associated with thromboembolic events. Currently, the CHA2DS2-VASc score is recommended for thromboembolic risk stratification in non-valvular AF patients. However, recent data suggested a potential role of atrial remodelling on thromboembolism. This study aimed to assess the association between left atrial low-voltage area (LVA) and history of clinical manifest as well as subclinical silent cerebral ischaemia (SCI) in AF patients. Methods and results: Two-hundred patients [64 ± 10.5 years, 75 women (37.5%)] with symptomatic paroxysmal (n = 88, 44%) or persistent AF undergoing pulmonary vein isolation (PVI) were prospectively enrolled. Left atrial LVA (bipolar voltage < 0.5mV) was evaluated by intra-procedural mapping (>300 points per patient) during sinus rhythm. Cerebral delayed-enhancement magnetic resonance imaging was performed after PVI for detection of pre-existing procedural-independent SCI. Over all, 17 patients (8.5%) had previous history of stroke. Pre-existing SCIs were detected in 135 patients (67.5%). Patients with previous stroke (4.0 ± 1.5 vs. 2.1 ± 1.3, P < 0.0001) and pre-existing SCI (2.7 ± 1.3 vs. 1.5 ± 1.4, P < 0.0001) had a significantly higher CHA2DS2-VASc score. LVA was significantly larger in patients with previous stroke (12.5 ± 8.5% vs. 3.4 ± 5.4%, P < 0.0001) as well as pre-existing SCI (5.8 ± 6.9% vs. 0.8 ± 1.7%, P < 0.0001). Multivariate regression analysis revealed that LVA was independently associated with the presence of SCI [hazard ratio (HR) per 1% LVA 1.13 (1.06-1.22), P = 0.0003] and history of stroke [HR per 1% LVA 1.36 (1.19-1.60), P < 0.0001] after adjustment of CHA2DS2-VASc score. Conclusion: Left atrial LVA is associated with history of stroke and SCI in patients with non-valvular AF and might improve thromboembolic risk stratification after confirmation of its predictive value in future studies.
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Müller et al. (2017) conducted an observational in Atrial fibrillation (n=200). Left atrial low-voltage area (LVA) was evaluated on Presence of subclinical silent cerebral ischaemia (SCI) (HR 1.13, 95% CI 1.06-1.22, p=0.0003). Left atrial low-voltage area was independently associated with silent cerebral ischaemia (HR per 1% LVA 1.13; 95% CI 1.06-1.22; P=0.0003) and history of stroke (HR 1.36; 95% CI 1.19-1.60; P<0.0001).
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